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064-230-019
E GEORGE WALLEN AP.--, 4-23-19,------ Y 44-1- Carnegie Rd, lot'. 103,' PP 4 i!bontr: S&N Const,,, magalia flt Permii# 4971-74p,E(util-., ELD 6f! 019� 05-1813 GAS �4ORTOT� -MARTfN726 CAR NE 14 GIE RD' SUPPORT ST C U I " ' , MAGALIA' RE RE(4 Cont; OWNER"' COMPACTION TEST RBQ.<' GAS STOVED PINGF1 -r 04-k'J3- CONTR: Lancer Permit#_4 Home s.,, Mgvl Issued Y- 5 contr: Lloyd R. Rober.-ts,'.Paradise Permit #156-77B ef;ew open deck '& covered deck/MH) 4-23-19 con r: er Const.,Magalia Permit f)13467-80B,P,E(new pri.garage) 4-23"19 ontr: Illumination Electric,Mag Permit#4465-80E(ele ser ch)gar. 64-23-19 Permit # 2768r82B(covj& screened porch over exist deA/MH contr: Sierra Const, Ppa KraAd IS 64-23-19 Contr- Atlas Const, Magalia Permit#362-84B(new covered patio & walk/MH) c� __ _ �! a/jam/� o �'� 2 wi 764.-230-6f9 PERMIT'#98-06275', . T HORTON., M.'D.'& G1 en do 1'a �r`, ti 14726 Carn-4ie Rd.., Ma A gAlia, Misc.116/MH -vt %9 A N ` i `3..! NOTES RESIDENTIAL PERMIT NO. _µO64-230�Uf9 " .._.._ __05-1813"'• . LGAS'STOVE TON, MARTIN 6 CARNEGIE RD MAGALIA OWNER` &PIPING 4 . i a y. SPECIAL CONDITIONS s CHECKED BY SRA FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY' ` USE PERMIT CONDITIONS • ' SUB -STANDARD HOUSING LETTER =— sTr Tr✓ �'EQr71IT Foe r1 -s s�-vvE A ' • r y �k ii j JOB FINALED (Date) Signature • S SPECIAL CONDITIONS s CHECKED BY SRA FLOOD CERTIFICATE REQ. FIRE SPRINKLERS REQ. SPECIAL INSPECTION ITEMS VERIFY' ` USE PERMIT CONDITIONS • ' SUB -STANDARD HOUSING LETTER =— sTr Tr✓ �'EQr71IT Foe r1 -s s�-vvE A ' • r y �k ii j JOB FINALED (Date) Signature J=OK 0 a Not OK Not . = NotReadyaCle MOBILE HOLIES Date MOBILE HOME UTILITIES (Plans) OK except 4's 1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support Sketch 3. Sewer, Location -Test -Fall -C/O -Concrete 4. Water, Location -Test -Easement Needed (Sketch) _ 5. Electricity; Location-Clearances-Gmd-/ /Amp -Concrete 6. Gas; Location -Test -Wrap;-/ P L'ft. / P Nat. or/ P L "ft1 P LPG 7. Well Clearance & Disconnect 8. Utility Clearance 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except Vs Date 1. Zoning Requirements -Setbacks -Easements Date 2. Footings; Size -Spacing -Marriage Line 3. Gas; MH Test -Demand -Valve -Connector 4. Electricity; MH Test -Crossovers -Breakers -Clearances 5. Drain; MH Test -Fall -Flex Connector 6. Water, MH Test-Regulator-Connectot '7. Water and Sewer Connected -C/O to Grade -HD Approval 8. Gas and Electricity Tagged 9. Tie Downs -Type -Installation Cert. 10. Exits; Insp.-Sketch 11. Cert. of Occupancy 10. Plumb.; Cir. Test -Water Supply Test 11. Light Niche Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PERMANENT END SYSTEM (ONLY) Date 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Blocking 4. Gas; MH Test -Demand -Valve 5. Electricity; MH Test 6. Water, MH Test 7. Water and Sewer Connected 8. Gas and Electricity Tagged 9. Exits 10. License Decals 11. Verify #'s with Office Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 MISCELLANEOUS Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except 1#'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts-Beams-Rftrs-Connectors Shthg-Frg-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings 12. Braced Wall Panels Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date POOLS (Plans) OK except #'s 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distance-GFI 5. Elec.; Pool Lighting; 15 Volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. •Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes-Enclosures-Panelboards-Ins. to Main Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test 11. Light Niche 12. Enclosure; Fencing -Alarms Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 J=OK 0 = Not OK = Not Applicable = Not Ready RESIDENTIAL (Single & Duplex) Date UNDERFLOOR (Plans) OK except #'s 1. Zoning -Setbacks -Easements -Flood -Slope 2. Ftg., Main; Soils-Elec. Gmd.-/ /" Ftg. Depth 3. Ftg_, Garage; Soils-Steel-Elec. Gmd.-/ /" Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ P' Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts-Wrapped 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors 7. Slab, Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test 11. Water Pipe; Test -Anchors -Regulator -Service Test 12. Electric Underground 13. Plenums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies 15. Access & Ventilation 16. Insulation Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date PLUMBING (Permit) OK except #'s 17. Water Htr.; Vent -Access -Combustion Air Baffle 18. Water Pipe, Test & Anchor -Nail Protection 19. D.W.V.; Test Fittings & Anchor -Nail Protection 20. Shower Pan; Test, First Floor -Tub Access 21. Test Tub & Shower, Second Floor -Tub Access as Pipe; Sixe & Anchors 23. Fire Sprinkler, Test Date )p -Z 1 -M -Card B-1 S Date Card B-1 Date Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s 24. Fixture & Transformer Clearance -Ins. Protection 25. Elec. Receptacles Spacing -Lights & Switches at Doors 26. Size Boxes & No. of Conductors Stapled 27. Romex Installed Close to Edge of Studs & C.J. 28. Equip. Ground made up w/Mech Fasteners -Bond Gas & Water 29. 2 Appliance Circuits in Kitchen & Conductor Size GFI 30. Subfeed Wire Size/ /ga. Cu or AI -AC. Wire Size/ /ga Cu or At 31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or Al Insulated Neutral O Yes O No 32. Service -Riser Conductors & Ground Main Disconnect 33. Equip. Clearances Panels-Motors-Mech. Equip. 34. Clothes Closet Light -Shower Light -Spa Light 35. Smoke Detector Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except #'s 36. A.C. Ducts Insulation & Support 37. Vent Fan, Exhaust above insulation 38. Condensate Drain & Overflow, Size & Grade 39. Furnace -Vent Access -Comb. Ait-Return Air Vent 115 Outlet 40. Attic Access & Platform if Furnace in Attic Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Permit) OK except #'s 41. Sills Proper Materials & Anchors 42. Walls Studs -Nailing Spacing & Braces -Plates -Sound 43. Bearing Walls over Girders & Floor Nailing 44. Draft Stop in Walls (rat proof) 45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs 46. Headers & Beams -Size & Bearing Date FRAMING (Continued) 47. Hangers -Post Caps -Anchors -Connectors 48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac.-Truss-Shting.-Rtng. 49. Fireplace Ties or Type AFlue-Fireplace Throat Clearance 50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 51. Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions 52. Garage Fire Protection Framing -RC Channel 53. Property Line Firewall & Openings 54. Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits 55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 57. Siding -Nailing Veneer 58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 59. Glazing Area -Glass Protection -Skylights -Plastic 60. Shear Walls; Nailing -Botts 61. Brace Interior/Exterior Wall Panels 62. Insulation -Walls -Ceilings 63. Infiltration -Walls -Windows Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except #'s 64. Ext. Steps -Door & Sidelight Protection -Landings 65. Smoke Detector 66. Furnace Vents -clearance -Comb, Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 67. Bedroom Exiting 68. G.F.I. & Bath Fixtures & Tub Access -Spa 69. Elec. Trim & Subpanel, Breaker Sizes & Labels 70. Stairs & Rails 71. Fireplace or Stove, Clearance -Hearth 72. Elec. Outlets at Wood Panel, Int. & Ext. 73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance 74. Elec. Outlets & Receptacles at Kit. Counter 75. Garage Fire Door, Swing -Landing -Closure 76. A.C. Duct in Garage -Damper 77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V. in Garage; Above Floor -Meth. Protection 78. Plb.; Elec. & Mech. Equip. Listed for Location 79. Elec. Receptacles in Garage (FFI.)-Romex Protection 80. Insulation -Foam -Looked in Attic 81. Guard Rails & Deck Construction -Post Caps 82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth Clearance Looked under Floor O Yes 83. Following InstldJDrive O Yes O NoMalks O Yes O WPlarlters O Yes O No 84. Stucco Brown -Finish 85. A.C. Unit Disconnect, Electrical -Plumbing 86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings 87. Water Well, Disconnect, Electrical, Plumbing 88. Exterior Elec. Trim, G.F.I. Receptacle -Underground 89. Ventilation Throughout House 90. Glass Protection 91. Corrections from Previous Inspections 92. Gas Test -Meters Tagged, Gas -Electric 93. Water & Sewer Connected -C/O to Grade -HD Approval 94. Energy Compliance Certificate -Other Certificates 95. Address Posted 96. Fire Sprinkler Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments at Final: State of California FOR INSPECTION CALL: Business, Transportation and Housing Agency Q��ytMror TELEPHONE# - Department of Housing and Community Development Dlvision'of Codes and Standards m 1 fi i : dye APPLICATION FOR:`""tlE� ❑ Alteration/Conversion❑Approval to Remanufacture ❑ Alternate Approval ❑ Technical Services ❑ Replacement Insignia Coding Inspection (SEE REVERSE SIDE OF FORM FOR INSTRUCTIONS_ AND ADDITIONAL INFORMATION) CONTRACTOR/OWNER BUILDER DECLARATIONS Not required /or Special Purpose Commercial Coaches or Recreational Vehicles 1. LICENSED CONTRACTORS 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. Exp. Date Contractor Date 2. OWNER-BOILDER DECLARATION I hereby affirm under penalty of perjury that 1 am exempt from the Contractors License Law for the following reason (Sec. 7031.5). Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade) or that he or She is exempt therefrom and the basis for the alleged exemption. Any STATE OF CALIFORNIA ewc% t Department of Housing & Community Development Division of Codes and Standards 8 a FINAL INSPECTION CERTIFICATQ01i/— .'Z�p G r BY: DATE: "U (District Representative) (ID o.) LABOR DATA: AREA: ❑ North 13 /South County No: PCA/ACTCODETR MILES TIME: INSP/ACT " TRAVEL TIME O INSPECTION DATA: JE!�rlvate Property ❑ MH PARK # HOME/UNIT FLOORSi VIOLATION DATA: TOTAL CORRECTIONS: S_F_E_ M_P_G/O_NP_ FEE COLLECTION AND OTHER INFORMATION: FEES: $ CK# DATE ITEMS ISSUED: HCD 59 ❑ Gas ❑ Electric ❑ M.I.A. SECTION 1 - UNIT INFORMATION I/We are requesting services for the following unit(s): rR Appropriate Box) ufactured Home/Multi-Unit Manufactured Housing ufactured Home/Multi-Unit Mfg. Hsg. Component Structure eational Vehicle mercial Coach (Occupancy Group ❑ Special Purpose Commercial Coach Decal or License No Serial Number(s) Manufacturer Name/ r Model Name J Year of Manufacturer Insignia/HUD Label Number(s) _ COLI . 0715 FEE 'D TR 104 J r_ DATE_'O- iTn5 AA NO. RT TO RT BY SECTION 2 - OWNER/APPLICANT INFORMATION • r���� .t� Owned Q. O- inhone No. :E33 Address )x,17 ;1 ( n L- City1 � County -L3u a zip 44 Location of t if Different Than Above I /� I. Applicant �4 I;fi /a� nd l , Address. _ i q-72 ( r f, G 2 City zip -7'S�'%s` Telephone No. i� l7 r7 %J `�� JI SECTION 3 - CONTRACTOR, ARCHITECT OR ENGINEER INFORMATION Contractor's Nam Address Architect/Engineer Mame Address SECTION 4 - DESCRIPTION OF WORK/ACTIVITY AND VALUATION ATTACHMENTS: ❑ Tledown Cert. ❑ Other Describe the proposed work/activity in detail. Attach additional pages if necessary. If structural alterations PERMIT NO: 21 FILE CLOSED or remanufacturing are proposed, complete plans, specifications, details, and calculations must accompany v this form. Check box D if plans accompany this application. Provide the make and model of any appliance I to be installed and providycomplete electrical calculations for any electrical alterations nr adnttinne I 1 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 California, and agree that if 1 should become subject to workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Applicant Date WARNING: PE Ate-- — COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS is 100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. License No. 4. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec.3097, Civ. C.). Lender's Name Lender's Address ' t - I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the abov mentioned property for inspection purposes. I- i aturg oim AP3 t or gent —Date/ HCD 415, Side 1 (02/96) DISTRIBUTION: YELLOW - D Indicate the Total Cost of the Work to be Performed 9 L r 700 AND I/We hereby make application for the services designated above. If applying for replacement of a lost insignia for the unit described in SECTION t above, I/we certify that there have been no alterations, additions, or modifications to the unit that wou'd affect the unit's compliance with California or federal law or the rules and regulations of the Department. ilf alterations, additions,'or'modifications have been made, a coding inspection must be obtained.) Signattire , 1 fi=t- t-1�1J.CiL'r1 Dater_ (Owner of unit must sign, when a replacement insignia is being requested). orrrrR+w: DEPARTMENT USE PPR ❑ CONDITIONS (see reverse side) of Department Representative ❑ Disapproved ife.. re erso side) W. 05 Date SEP 2 9 qnn� BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES. BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.net\dds PERMIT NO. BP051813 LICENSED CONTRACTORS 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 Issued Date: 07/11/2005 APN: 064-230-019-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 14726 CARNEGIE RD MAG Date: Contractor: Map Index: Description: INSTALL GAS STOVE AND PIPING OWNER43UILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a NORTON MARTIN D & GLENDOLA permit to construct, alter, improve, demolish, or repair any structure, prior Owner: to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of 14726 CARNEGIE RD the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or MAGALIA, CA she is exempt therefrom and the basis for the alleged exemption. Any 95954 violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): 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 (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does Applicant: NORTON MARTIN D & GLENDOLA such work himself or herself or through his or her own employees, provided that such improvements are not intended oi� offered for sale. If however, the building or improvements are sold within one 14726 CARNEGIE RD year of completion, the owner -builder will have the burden of MAGALIA, CA proving that he or she did not build or improve for the purpose of 95954 sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors: State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). Contractor: O I amExe Exempt under Article 3 of the Business and Professions Code l- Date:....7/ — ZOWner: gi" CJa&.e 4612 "" 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 License #: workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit ` is issued. „mil I have and will maintain workers' compensation insurance, as Architect: required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Engineer:. insurance carrier and policy numberare: Carrier: Policy Total Square Ft: 0 S.F. ❑ 1 certify that in the performance of the work for which this permit is Valuation: $0.00 (f issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' Census Code: compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. A p�,F1'/) (J Date: 7 — / f — O !C Applicant: R a Jd WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor ' code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit i ereby� s d undo the apSkcable provisions of the Bntte County CodR enrt/or I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Resolutio to do ork ' dicate a ove r hich fees have been paid. Name: BY Date: PERMIT EXPIRES ON: Date Address: ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. 1 agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purpossse/s. Print Name: 0 F �-/' b i^ I h 1- C n Signature: �——/1 Date: 'TX-Owner ❑ Contractor 13 Agent for Owner ❑ Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION Website: www.buttecounty.net/dds **PLEASE PRINT CLEARLY** OWNER Last Name o d -n R t Name Address City � lat Zip Phone Fax E-mail APPLICANT NAME CONTRACTOR Name City Address w q \ City City State Zip Phone 97 — y/ C, / Fax E-mail E-mail Lic. It Class APPLICANT NAME ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Planner Fax E-mail State License Number APPLICANT NAME Name Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X g e4li�� For office use only: Zoning Flood Zone SRA Yes I No Occ. Type Const. Subdivision Name Map Book I Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT NO. BIN # LOCATION Property Address y Cross Street WORKER'S COMPENSATION Policy Number ooc� / S3�oy Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Page 1 of 2 Description or Scope of Work: 1:54.5. 'riPi�v� �Tati� �IrS Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Received b : Amount: Bldg SRA Receipt It: Sheriff i/ � SMIP � Dater 11,0) � �� Other i Total REV 2-24-05 R 14 - SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, with wet.signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes! ❑ 4. Energy compliance design and supporting documentation in duplicate. ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 7. 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. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts. ❑ 12. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, please contact a Permit Assistant at (530)538.7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 2-24-05 Butte County Department of Development Services ADMINISTRATION * BUILDING' GIS * PLANNING 7 County Center Drive Oroville, CA 95965 (530) 538-7541 Telephone (530) 538-2140 Facsimile Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a pen -nit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that your plan to subcontract, you should be aware of the following information for your benefit and protection: o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. o If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. o For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner -builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. J ely, el C. Vieir C.B.O. er, Building Inspection NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code. .�,vTa-�xu:,a.�:;.=at;;S':s::xierr.tai•:�;.�.--„-_-`;:.�;r�x,:r.:�,:w:...—�=:e�r�:�.1:ts,. Attention Property Owner: An "owner -builder” building permit has been applied for in your name and bearing your signature. Please complete and return this infonnation 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. I personally plan to provide the major labor and material for construction of this proposed property imp ovement: YES [ ] NO [x]. 2. I HAVE [ HAVE NOT [ ] 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: PHONE: CONTRACTOR'S LICENSE NO: 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: ADDRESS: PHONE: CONTRACTOR'S 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 SIGNED: PROPERTY OWNER: DATE: •y - / i , c_6 - NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. Rev'd 11/4/2004 --.-T, .l'c� "[ oF4'1 <: f•S +Y`+ F`� ira : x: j a?y�d�'+! 3i ?'r` Y •- .. h r3. ,. ., � �. •, 'fes. X . '7r •y. _. "P:: u -v..-.. a^.7!A- y_. i'^-, .. :tT TN ^+ T') Ir -11 F . COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT (Vo (9!5 p ASSESSOR PARCEL NUMBER. L 30-0/7 =GNI _ BUILDING PERMIT OWNER 1 LEPHONE 3— SO,FT. OCC. BUILDING V LUATION OWNERS MAILING ADD S , i• • i �C/ {1 0 r1 dCONTRACTOR'S NAME TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER LENDERS MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checkiri Fee $ BUILDING ADDRESS ` I LanOAAEnergy Plan Checking he $ $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filin `Fee 20.00 USEOFSTRUCTURE SF K Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heatpump 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: ( ((� ' Jo�PERMI Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W 920.00 FEE S J ELECTRICAL PERMIT Filing Fee 20.00 800V LESS Main Service 200. 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 full force and effect.+ License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that,l am exempt from the Contractors License L w 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. ❑ I, as owner of the property, am exclusively contracting with licensed contractors _, to construct the project. 13 1 am exempt under Sec. Business and Professions Code for this reason s s Main Service zoo. To loon. 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( a ACC. BIDS. SO so 3.5¢x. NOW SII. '"T -OUTLET UITS 97.50 APPARATUS d PSINGOWERLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES 20 @ 1.00 sAt 50 Ex. Occup. ouTLEEDTs RESID.GEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00'2 0 PERMIT FEE $ L4 ' -P)- QV 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.) ❑ 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 forthwith comply with those provisions. X Date_ Signature of Applicant - ❑ Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" 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 FES $ Mobile Home Installation Fee $ Energy Inspection Fee $ CONST. TYPE t •jj • O TOTAL FEE $ `- 3U HA2. D. FEES IMP I FLOOD I CDF I PARCEL PD HD ISSU This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicaT 'above for which fees have been paid. By � ( k' r Date q-/ 398 PERMIT EXPIRES ON (Da ts Receipt No. WHITE-D.D.S.-B. . CANAR -A S S R PINK -INSPECTOR GOLDENROD -APPLICANT /" Alk COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive - Oroville, California, 95965 - Telephone (916) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATI6N�4ND PERMIT � `f�(�49 ASSESSOR PARCEL NUMBER —Z-30-0/ =ON _I BUILDINGPERMIT OWNER LEPHONE 3- SO. FT. OCC. BUILDING V UATION OWNERS MAIUNG S 0 (`1, CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAIUNG ADDRESS CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAIUNG ADDRESS Plan Checking Fee $ BUILDING ADDRESS I Energy Plan Checkingee $ PERMIT FEE t LOT NO. SUBDNIS IONS NAME PARCEL MAP PLUMBING PERMIT Filin 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 j❑ Utilities ❑ Installation ❑ Other _1.,6iG JOC.� Describe Work: p1. 2 Gas piping system 1 - 5 outlets 15.00 Buildingsewer 15.00 Mobile Home S G W @20.00 PERMI FEE S ELECTRICAL PERMIT Fling Fee 20.00 Main Service zo.A0.LEss 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 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.P License Class LIC. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Lor the following reason: 1, as owner of the property, or my employees with wages as their sole compensation, W 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. I am exempt under Sec. Business and Professions Code for this reason gthj,y —922ty <t,.sy Main Service 200A TO IGOOA 46.00 NEW CONST. DWELLINGoccuP. so OR ADDNS. ( a ACC. BLos. 3.50FT: NEW CONST.MULTI-OUTLET NON-RESID. C CIRCUITS 97.50 OWER APPARATUS 8 SINGLE OUTLET CIR. Ex. OCCU OUTLET OR FIXTURES SAL ' a Ex. Occup.OUTUFTs REESSID.OEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirinq 23.00 '23,6a PERMIT FEE $ WOFFKERS' COMPEnATI N 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 Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE S 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.) 10 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 therE workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. ��� X =�. Date L4 Signature of Applicant - Owner ❑ Contractor ❑ Ag nt 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 $ Energy Inspection Fee $ Jq co T. TOTAL FEE $ 43 , -Z. D. FEES IMP FLOOD CDF PARCEL PD HD SU This permit is hereby issued under the applicable provisions of the B County Code and/or Resolutions to do work indicat above for which fees have been paid. By Date PERMIT EXPIRES ON LI -13 -f Date Receipt No. WHITE-D.D.S.-B. CANARY -A S SS R PINK -INSPECTOR GOLDENROD -APPLICANT Attention Property Owner: 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. I personally plan to provide the major labor and materials for construction of the proposed property improvement: YESW NO[ I. 2. I HAVE] HAVE NOT[ ] 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: CONTRACTOR'S 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: CONTRACTOR'S LICENSE NO. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: NA1� ADDRESS PHONE TYPE OF WORK SIGNED: V PROPERTY OWNER: SOCIAL SECURITY NUMBER: X DATE: � `" 1,3 ` f3 NOTE: This owner -Builder Verification is required by Section 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. May 199i 2.26 .,�. ,.--...-. �-c� v-. -. `�. rr :^�'ti-�{ i�'ws�:+►nM'S �a`.i,'�f!�j�"!sh�.�,.:, ; "sem--'^--�r"""'� .-, .. { + ,� •— � 3.1•.4i.�. C 1 i "" F.. �� .. ' . ,.� ' ..� ._ . , . _ ,. . �� .,� ii 1 '- . i i. � . _ .,'� � ' s j �� .. ' . ,.� ' ..� ._ . , . _ ,. COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 72 � APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT OWNER TELEPHONE SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS /4-/726 r CON RACY R'5 NAME p �('�, K _ TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 10.00 Permit Fee $ ARCHITECT OR ENGINEER — LICENSE No. Plan Checking Fee ,$' Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 �A Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME ARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE ----'� SF ❑ Duplex❑ Mabilehome❑ Other 'SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W O.00e TYPE OF WORK New F-1 Addition Remodel❑ Utilities ❑ Installation[] Other d Describe work: _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 �Jl ►'T 0V OR L Main'se"rvice 100 AMP OR5LESS } 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification 1, as the owner, Or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ ossa the owner, am exclusively contracting with licensed contract- 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.& OR ADDNS. ACC. BLDGS. 2/, z2sgft NEW CONSTR. ULT' -OUTLET NON -RE BRANCH CIRC ITS 2.50 ea /POWER APPARATUS M (SINGLE OUTLET CIR. EX. Occu po UTLETS OR F.XTURES 20050a MAL@30 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA. 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 /f Permit Fee Contractor $ S 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 FiIingFee 10.00 Heating Cooling Hood 3.00 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 County of 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 , � �- t �-1 1?- �� -^ `�1 Date Signature a of Appli�— OwnerZ Contractor EJAgent F-1 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 E HAz CUA PARK CHL PAR PD [HE) I uE This permit is hereby issued under sions of the Butte Count Code and/or workindicated above for which fees DIRCTO,jA F PUBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do have been paid. WORKS cy Date h Receipt No. ��� % WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF' BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - OrovillegialArnia 95965 - Telephone: 916/538-754. Z APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT OWNER TELEPHONE 8 73 /123 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS L/ 6 f: Q CON RACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is LENDER'S MAILING ADDRESS Filing Fee $ 10.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS /` U �) Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 4 !%a Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME TARCEL MAP Water piping 5,00 Each pas water heater or vent 5.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome❑ Other 'SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home I S I G JW I 10.00e TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] Other Describe work: f Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 1000 AMP ORV OR LESS10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): El 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 1, as the owner, Or my employees with wages as their Sole Compen- Pi sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.& OR ADDNS. ( ACC. BLDGS. /20sgft NEW CONSTR ULT' -OUTLET NON-RESID BRANCH .CIRC ITS 2.50 ea POWER APPARATUS &) (SINGLE OUTLET CIR, Ex. Occup(OUTLETS OR FIXTURES 20000¢ 9 ALO 30 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Iyirin g 15.00 /,T Permit Fee Contractor $ S� 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 FiIingFee 10.00 Heating Cooling g Hood 3.00 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 C unty in consequence of the granting of this permit. o�p� %� Date ��—/l / Signature of pplicant — OwneX 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 FEE TOTAL ALSCHL HAZ CUA PARK I FLD I PAR PD HD Is UE This permit is hereby issued under sions of the Butte County. Code and/or work indicated above for which fees I CTO F PUBLIC BY PERMIT EXPIRES Date�— the applicable provi- resolutions to do have been paid. WORKS Date f Receipt No. WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT �l7 COUNTY OF BUTTE - DEPARTMEt.4P. 'PUBLIC WORKS - BUILDING IV ION 7 COUNTY CENTER DRIVE - OROVIL`LE, CALIFORNIA'95965 - TELEPHONE: 916/536-7541 PERMIT_. APPLICATION DATA SHEET Permit No. 8 OWNER 2�r �O7_10 10 *n A. P. No. Proposed Building Use y bBuilding Inspector Date 14 -1 At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED 1. All items have been submitted. 2. Plot plans in duplicate/triplicate, signed by preparer of plans........ 3. Complete plans in duplicate/triplicate, signed by preparer of plans .. 4. Complete engineered plans and calcs, with wet signature on plans . . 5. Hazardous Material Form ....................... `................... 6. Energy Design Compliance and supporting documentation ......... 7. Statement of Intent for Non -Heated and AC Buildings ...:.......... 8. Engineered truss details and layout in duplicate (required prior to,plan check) 9. Mobilehome installation data including manufacturer's installation instructions....................................................... 10. Fees of $ ........................ 11. Chico Urban Area fees paid ....................................... 12. Park fees paid .................................................... 13. School District fees paid .............. 14. Sanitation approval from Health Department 15. City of Chico plumbing permit ..................................... 16. Plot plan and business license approval from City of (see City for other requirements) 17. Planning approval for (A),,Use: (B) Parking: ...... 18. Improvements may be required. Contact Land Development Section DPW 19. Driveway permit (construction approval required prior to occupancy) 20. Pre -Inspection for required Pre-Inspec.request tol Building Inspector (Date 21. Contractor's license information (No., Name Style, Classifications ... 22. Certificate of Workmans Compensation Insurance .................. 23. Owner -Builder Verification (Given to owner ❑, Mail to owner o) ..... i 24. Recorded copy of Agricultural Acknowledgment Statement ......... 25. Letter of signature authorization ................................... i 26. ' 27. When you issue the permit, process as follows: Mail to owner. Z Mail to contractor. Telephone and hold for p pickup at office. Deliver w/inspector. Other_ Copy of- plans sent Appl i Health Dept., Fire Dept., Other_Z Date The. following data must be submitted prior to permit issuance 1. Index permit for above items No. 2. Additional items required: Date (Circle ne/item not checked above)., Contractor, designer, owner, was advised of"above required data by_phone---naiI—counter by ..date Contractor, designer, owner, was advised`df,above required data by—phone —ma ll—counter by : date Plans checked by .4 .....to Plans approved by Date _ Sets of plans on hold in File cabinet AP folder Copy—DPW (L O PERMIT NO. 156=77B PERMIT EXPIRES OWNER George Wallen I CONTR. Lloyd R—cRoberts, Paradise LOCATION (A.P. 64-23-19 ) r: 165 Carnegie Rd., lot 103, PP#14, Magalia p, ,X A j[N77[[ 5. J t, J 1' (i l.1 Temp. Power Pole Called PG&E Temp. Elec. Serv. Called PG&E Temp.4Gas serv. Called PG&E f FINALED (Date) (Sign tu' e) V COUNTY OF BUTTE — DF—PAR.MENT OF PUBLIC WORKS , BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) P_ MING Setback — o Firewall Soi I Piping Forms Parapets 1st Floor Main Bldg. Restroom Finish 2nd Floor —Footings Windows 3rd Floor Stemwall Siding To out Slab Roof Sheathing Water Piping Piers Roofing Sewer Garage Fdn. Vents Fixtures Footings StemwaI l Garage Vents Insulation Water Htr. Heaters Slab Carport Footings Prov. for physically handica e Conformance of ex. structure Appliances Gas Piping &Test Tem . Gas Slab Sanitation Patio _Final FIREP.LACE Final Footings Footing ELECTRICAL Masonry Walls Throat Rough Reinf. Steel Final Fixtures Bond Beam r FIRE SPI IINKLERS Motors Framing_7 Test Water Htr. Stucco Final Subpanels Mesh MECHANICAL Grd. Fault Prot. .Scratch Heating Service Brown Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation Permanent Door Closer Final Final DATE REMARKS OR CORK CTIONS (NOTE: An entry must be made on this form each time you visit the job site.) F t COUNTY OF BUTTE — DEPART.MENT OF PUBLIC WORKS ' y 7 County Center Drive — Orovi Ile, California 95965 Telephone: 534-4;41 APPLICATION AND PERMIT X� . IT BUILDING If I Owner �� �o r SQ. FT. OCC. BUILDING VALUATION Mai I i ng Address Z 0 0 ✓ o e DQ f< O a D Telephone No. . Fireplace Contractor Ll—b y�✓ /�� �'j p 6 I s Total Valuation 020 • OO Mailing Address p k 2 O Permit Fee Plan Checking Fee&/or Penalty ,,q -✓`y d , 5 C� Telephone No. i.3 — p.s'9 Permit Fee $/- / ^ C Building Address L4PLUMBING y'��C� C' No. @ FEE PERMIT FILING FEE J$3.00 A .s L Each Trap 1.50 Repair drainage or vent piping 1.50 • / /4 D'T/ D Water piping 1.50 Each gas water heater or vent 1.50 A. P. No. 3 — I Zoning 8 Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 F San o Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA I Parking DePa a ion Parcel Map 60' R/W Imm�prroovements Lawn sprinkler system 2.0Plans0 Bldg. Plans Recd Parcel Approval PI���ApprovaI Permit Fee $ NEW ADDITION ❑ UTILITIES ❑ OTHER ❑ ELECTRICAL @ I FEE _No.1 PERMIT FILING FEE $3.00 Main service 100 AMP ORV OR LESS5.00 Main service EA. ADO'L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home © Others ❑ Main service OVER 600V 100 AMP OR LESS 25.00 Main service EA. ADD'L 100 AMP 1.00 tOR /' 6 Y NEW CONST./DWELLING OCCUP. & AODNS. ACC. BLOGS. ) 20sgft ; NEW CONSTR. MULT I.OUT LET NON•RESID. (BRANCH CIRCUITS) 2.50ea NEWCONSTR. /POWER APPARATUS &) NON -RESID. VSINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Pr fessions ode un the name style of: 2 Ex. Occup(OUTLETS OR FIXTURES) ''2¢ BALRt Ex. Occu FIXED APP LNS. OR P•(OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No.4R _. aPl// Classification Misc. Wiring 6.25 ❑ I am exempt from the Contractors License Laws of the State of California. Permit 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. ❑ �he placed on file with the County of Butte a certificate of men's Compensation Insurance. rtify that in the performance of the work for which this pt 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.1 @ I FEEPERMIT 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 I authorize representatives of the County of B e to enter upon the - qr TOTAL PERMIT FEE $ 120 This permit is hereby issued under the applicable provisions of 7_1J WT White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR 0 PUBLIC WORKS By pate - z -K-7 7 ilding permit expires Date /- x`(-76' PERMIT NO. _ 362-84B v . PERMIT EXPIRES OWNER GEORGE WALLEN 7 CONTR. Atlas Const, Magalia ASSESSOR PARCEL 64-23-19 LOCATION 14726 Carnegie Rd, Magalia t� 1 s t.4 L Temp. Power Pole Called PG&E Temp. Elec. Service Called PG&E Temp. Gas Service Called PG&E i JOB FINALED (Date) Signature V J = OK 0 = Not OK — = Not Applicable tie = Not Ready r MOBILEHOMES MISCELLANEOUS Date MOBILEHOME UTILITIES (Plans) OK except H's 1. Zoning Requirements—Setbacks—Easements Date DECKS, COVERS, CARPORTS, ETC. (Plans) OK except N's 1. Zoning Requirements—Setbacks—Easements 2, Soils; Special MH Support—Sketch _ 2. Footings; Size—Depth—Spacing—Conneclors 3, Sewer; Location—Test—Fall-C/O—Concrete _ 3. Decks; Girders and/or Joists—Decking—Bracing—Stairs—Rails — 4. Water; Location—Test—Easement Needed (Sketch) 4. Wood Awn.; Posts—Beams—Rftrs.—Connec.—Shthg.—Rfg.—Bracing_ 5. Electricity; Location—Clearances—Grnd.—/ / Amp—Concrete _ 5. Alum. Awn.; Columns—Connections—Splice—Decal—Enclosures 6. Gas; Localior-Test—Wrap:/ /"L"ft./ /"Nat. or/ /"L" ft./ /"LPG 6. Carports; Windows—Doors — r 7. Utility Clearance 7, Elec. —� Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date Card -BI Date MOBILEHOME INSTALLATION (Plans) OK except H's Card -BI Date _ Date Card -BI Date _ POOLS (Plans) OK except q's 1, Zoning Requirements—Setbacks—Easements 1. Setbacks—Easements 2, Footings; Size—Spacing—Marriage Line 2. Soils; Compaction—Structure Stability 3. Gas; MH Test—Demand—Valve—Connector 3, Pool Structure; Steel-Connections—Thickness—Dead Men—Lining 4. Electricity; MH Test—Crossovers—Breakers—Clearances 4, Elec.; Receptacles and Lighting; Distances—GFI• 5. Drain; MH Test—Fall—Flex Connector 5. Elec.; Pool Lighting; 15 volts—GFI 6, Water; MH Test—Regulator—Connector 6. Elec.; Enclosures; Conduit Entries—Terminals—Listed' 7, Water and Sewer Connected—C/O to Grade—HD Approval 7, Elec.; Bonding; Metal w/5'—Circulating Equipment—Heater 8. Gas and Electricity Tagged 8. Elec.; Grounding; Equip. w/5'—Circulating Equip. -Pool Lghtg. Boxes—Enclosures—Panel boards—Ins. to Main in Conduit 9, Exits; Insp.—Sketch 10, Cert. of Occupancy 9, Health Department Approval 10. Plumb; Cir. Test—Water Supply Test Card B -I Date Card -BI Date Card -BI Date Card -BI Date Card B -I Date Card -BI Date Card -BI Date Card -BI Date V = OK ' 0 = Not OK - = Not Applicable = Not Ready RESIDENTIAL (StagAl:and Duplex) � Date UNDERFLOOR (Plans) OK except#'s Date FRAMING (Continued) 1. Zoning requirements -Setbacks -Easements 48. Property Line Firewall & Openings 2. Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth 49. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits 3. Ftg., Garage; Soils -Steel- / /" Ftg. Depth 50. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 4. Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth 51. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab 52. Siding -Nailing -Veneer 6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab 53. Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access 7. Piers -Fireplace Ftg.-Steel 54. Glazing Area -Glass Protection -Skylights -Plastic 8. D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test 55. Shear Walls; Nailing -Bolts 9. Gas Pipe; Size -Anchors 10. Water Pipe; Test -Anchors -Regulator -Service Test 11. Electric; Underground 12. Plenums & Ducts; Clearance -Material -Support -Ins. 13. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date FINAL (Plans) OK except N's 56. Ext. Steps -Door & Sidelight Protection -Landings Card -BI Date _ Date Card -BI Date PLUMBING (Permit) OK except q's 14. Water Hl.; Vent -Access -Combustion Air 57. Smoke Detector 58. Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor -Ducts -Meth. Protection 15. Water Pipe; Test & Anchors -Nail Protection 16. D.W.V.; Test-Fttngs & Anchors -Nail Protection 59. Bedroom Exiting _ Shower Pan; Test, First Floor -Tub Access 60. G.F.I. & Bath Fixtures & Tub Access _ _17. 18. 19. Test Tub & Shower, 2nd Floor -Tub Access Gas Pipe; Size & Anchors 61. 62. Elec. Trim & Subpanel; Breaker Sizes -Labels Stairs & Rails - -" 63. Fireplace or Stove; Clearances -Hearth 64. Elec. Outlets at Wood Panel; Int. & Ext. Card -BI Date Card -BI Date 65. Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance Card -BI Date Card -BI Date 66. Elec. Outlets & Receptacles at Kit. Counter Date ELECTRICAL Permit OK except q's 67. Garage Fire Door; Swing -Landing -Closer 68. A.C. Duct in Garage -Damper - 20. Fixture & Transformer Clearance -Ins. Protection 69. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.- In Garage; Above Floor -Meeh. Protection 21. Elec. Receptacles Spacing -Lights & Switches at Doors 70. Plb., Elec. & Mech. Equip. Listed for Location 22. Size Boxes & No. of Conductors -Stapled 71. Elec. Receptacles in Garage; (G. F.I.)-Romex Protec. 23. Romex Installed Close to Edge of Studs & C.J. 72. Insulation -Foam -Looked in Attic ❑Yes 24. Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water 73. Guard Rails & Deck Construction -Post Caps 25. 2 Appliance Circuits in Kitchen & Conductor Size 74. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes - --i8. 26. 27. Subfeed Wire Size i / ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al, Insulated Insulated Neutral FYes El No Service -Riser Conductors & Ground -Main Disconnect 75. Following instld.: Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No; Planters ❑Yes ❑No 76. Stucco; Brown -Finish -_ 29. Equip. Clearances; Panels-Motors-Mech. Equip. 77. A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet - 30. Clothes Closet Light -Shower Light -_ 78. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Clangs. ------ Card B-1 ------------ ----- Date Card -BI Date 79. Water Well; Disconnect, Electrical, Plumbing 80. Exterior Elec. Trim; G.F.I. Receptacle -Underground 81. 82. Ventilation throughout House Glass Protection _ Card B -I Date Card -BI Date Date MECHANICAL (Permit) OK except N's 83. _ Corrections from Previous Inspections 84. Gas Test -Meters Tagged; Gas -Electric - 31. A.C. Ducts; Insulation & Support _ 85. Water & Sewer Connected -C/O to Grade -HD Approval 32. Vent Fan; Exhaust above Insulation 86, Energy Compliance Certificate -Other Certificates _ 33. _Condensate Drain _& Overflow; Size & Grade 34. Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet 35. Attic Access & Platform if Furnace in Attic Card -BI• Card -BI _ ----- ___ _-___ _-__-____-._- _ Date - _ _ Card -BI Date Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date FRAMING Plans OK except q's Comments at Final: 36. _37. 38. 38. 3_9. 40. Sills; Proper Material & Anchors _ _Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound Bearing Walls over Girders & Floor Nailing_ Draft Stop in Walls (rat proof) Fire Stops; Furred Ceilings -Stairs -Chases -Tub 41. 42. 43. 44. 45. 46. 47. Header & Beam -Size & Bearing Hangers -Post Caps -Anchors -Connectors Cing. Joist-Rfir. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng. Fireplace Ties or Type A Flue -Fireplace Throat Attic Access: Size& Romex Protection -Draft Stop -Ins. Baffles _ Bdrm. Windows -or _Exiting Doors -Sill H_g_t. & Dimensions__ _ Garage Fire Protection Framing (NOTE: Anentry must be made each time you visit jobsite) COUNTY OF BUTTE - DEPARTMENT SOF PUBLIC WORKS PERMIT NO. —. 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 _ APPLICA+� 166 0 PERMIT :347/ ASSESSOR PARCEL NUMBER ✓ /fJ_ z NING BUILDING PERMIT OWNER L� Ali TELEPHONE S0. FT. OCC. BUILDING VALUXTIOVI �Z " W R'JM,ILING ADDRESS397 �~ l.� T7 /T P_�cG/ pA�A4 <OR'S NAME 1 TELEPHONE D CON RACTOR'S MAILING 9 RESS O / �/ Fireplace LENDER CONSTRUCTIONUNKN OWN --77 Total Valuation $ !`• -n Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MA, LING ADDRESS Permit fee $ /s BUILDING ADDRESS -7a(, ` b���Ob PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar Water Heater 20.00 Water piping 5.00 LOT NO. SUBDI VISIONNA E PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SP Duplex❑ Mobilehome5K Other SPECIFY Building sewer 5.00 Mobile Home I S I G W 10.00e TYPE OF WORK Newlkf Addition ❑ Remodel ❑ Utilities ❑ Installation Other Describe work: �%P-o P �-�' w�-�= Permit Fee $ Contractor ELECTRICAL PERMIT FilingFee 10.00 Main service 8001 OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING OCCUP.&` OR ADDNS. ACC. BLDGS. I 2I/20sgft 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 -7Code C�and my license is in full force and effect. License No./%A/ 7f Sr' Classification ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONSTR U TI -OUTLET 2,50 ea NON-RESID BRANCH CIRC ITS. NEW CONSTR. /POWER APPARATUS IN NON-RESID. \SINGLE OUTLET CIR. Ex. OCCUp(OUTLETS OR FIXTURES BAL030 FIXED APPLNS. OR EX. OCCUp. OUTLETS (RESID,) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor MECHANICAL PERMIT FilingFee 10.00 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 Consent to Self -Insure. V 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. Heating Cooling Hood 3.00 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 a granting of this permit. Z"G /� 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 $ �ap TOTAL PERMIT FEE $ OCCUP. GROUP rE OF CONST. ,•AvP/ PARC L PD ND I 0E This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRE TOR OF PUBLIC B P MIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date Z Receipt No. 2✓��% WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT P.ERMIT NO. 3467-80B,P,E PERMIT EXPIRES l� I f O OWNER George Wallen. Marler ftst.,'Magalia CONTR. 64-23-19 4, LOCATION (A.P. 165. Carnegie Rd.,Iot 103, PP#14, magalia r. 'J, Temp. Powe�Pole Called PG&E Temp. E14 Serv. �% ��� PG&E Cal ed Temp Gas Serv. ailed PG&E { i OB FINALED COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS -Y BUILDING INSPECTION RHORD BUILDING Setback Q Forms (� Main Bldg. Footings Stemwa I I Slab Piers Garage• Footings ,7— Stemwall Slab Carport Footings Slab Patio Footings Masonry Walls Reinf. Steel Mesh Scratch Brown Finish terior Latl )or Closer Water Piping MOB1LEHOI Water Piping BUILDING (Cont'd) Firewall ara ets Restroom F Ish Windows Sidin Roof Sheathing Roofing Fdn. Vents o Garage Vents 4 Insulation Prov. for physically handicapped Conformance of ex. Footin Throat Final Test Final Heatin Cool in I Final ILITIES Elec. Service Sewer iTALLATION - - - - - - - - - - - - - Support Drainage FIREPI FIRE SPAIN Solt. Piping 1st Floor 2nd Floor . 3rd Floor Topout Water Pi in Sewer p' I Fixtures ' Water Htr. Gas Piping& Test Temp. Gas 'Sanitation E Final 4( ELECT CAL Fixtures t <LE RS Motors Water Htr. Subpanels ICAL Gird. Fault Prot. Service '71N Temp. Pole I Final Elec. Pedestal Gas Piping Elec. Continui Gas Piping DATE REMARKS OR CORRECTIONS r��� �� M cs` IV �'z5'-�'v GCI O� �• G/�{i l � G 4 (NOTE: An entry must be made on this form each time you visit the job site.) � cvU COUNTY OF BUTTE / Department of- Public Works 7 County Center Drive Oroville --- �-534-4541 ELECTRICAL 19FORMATION FOR DE -RATING MOBILEHOMES Owner P1 G=—_ Location NPk CC AS..I'. N Mobilehome Installation Permit No.�- FILL IN INFORMATION FOR ITEMS 1 THRU 10 Watts 1. Width x Box LengthS� x 3 jam��� 2. 2 Kitchen Appliance Circuits .... ..... .... 3,000 3. 1 Laundry Circuit ...... ................... = 1,500 4. Ovens ............................... ..... 5.'. Cook Stove Top ..................... .......o 6. Hot Water Heater ............................ 7. Dishwasher &Disposal. ................ _ 8. Clothes Dryer ............ ......... = r 9.' Other (specify, i.e., motors, exhaust n , c•) l :. p 0Q ub-total - Watts ..... ' First 10, w t �s�00%.' ............................... �J = 10,000 // Rem ping. watts @ 40%'... � - L%...... _ (D� 10. Air onditioner c:V watts @100/.. Largest Demand ?? = ;11300 entral Heat System--�2r(7j0 watts @ 65%.. 67, TOTAL DEMAND WATTS REQUIRED............... _ "Demand Watts Required" - 230 ............. .............- AMPS 'De -rate Mobilehome to .................................. AMPS %ts.`^ 0o Uy'� V� F ell m �� U w CG W L COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 = Telephone 916/534-4541 APPLICATION AND PERMIT ERMIT� A55I&50-R,P_�L yLy�BER Z BU16MNG PERMIT OWN R if 0� ' Y TELEPHONE SO. FT. OCC. BUILDING VALUATION OWNER'S MAI NG ADDRESS COACTOR'S NAME• f AT164 �Lr3cT' TELEPHONE CONTRACTOR'S MAILING ADD ESS cr�� + n I CONSTRUCTION L DERt UNKNOWN_ Fireplace Total Valuation is LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT ENGINEER'S MAILING ADDRESS Permit fee $ BUILDING ADDRE /2 PLUMBING, -PERMIT Filing Fee 3.00 Each Trap 1 11 1 2.00 Repair drainage or vent piping 2.00 Water'piping LOT NO. SUBDIVISION NAMEPARCEL MAP Each pas water heater or vent 2.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF ❑ Duplex[] Mobilehome)r Other SPECIFY Building sewer Lawn sprinkler system 2.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other Desoribe work: _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee Main service i$o AMP ORV OR LESS5.00 �� , Main service EA. ADD'L too AMP 2.50 .NEW CONST. DWELLING OCCUP.& OR ADDNS. ( ACC. BLDGS. 2¢sgft 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 Profess. s e and m license is in full rce a d effect. License N �- Classification ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason MU NON.RES D RJBUL CIRCUITS 2.50 ea NEw CONSTR. ( POWER APPARATUS &) NON.RESID. SINGLE OUTLET CIR. so @ � Ex. Occ Up(OUTLETS OR FIXTURES BALOICC Ex. Occu FIXED TS (RESAPPLNS. OR p•(DUTLETS (R ESID.) EA, 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 6.25 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 Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ❑ I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT FiIingFee 3.00 Heating Cooling Hood 2.00 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 County of Butte to enter upon the above-mentioned property for inspection purposes. l liabil' ies, udgments, costs, and expenses which may in any way accrue id unty in cons t graencs ofnting of this permit. ii1gn.tualso agr o ave, indemnify and keep harmless the County of Butte against Date re of Applicant — Owner ❑ Contractor E] 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 $ Land Development Fee $ TOTAL PERMIT FEE $ OCCUP. GROUP TYPE OF CONST. PARCEL PD No ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DI ECTOR OF PUBLIC By "- — PERMI EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Dat a? ' Receipt No. 2t L 7JI WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE Department of Public Works 7 County Center Drive �J Oroville ----- 534-4541 ELECTRICAL INFORMATION FOR DE -RATING MOBILEHOMES Owner CU P C, 1��� Location I l®.) {�-Ct�(�� �> NN Mobilehome Installation Permit No, ��n % P©? R F, FILL IN INFORMATION FOR ITEMS 1 THRU 10 i Watts 1. Width x Box Length x 3 2,. 2 Kitchen Appliance Circuits = 3,000 3. -1 Laundry Circuit = /1,,500 4. Ovens ....................... ..... _ //goo goo 5.' Cook Stove Top ............. ................... 6. Hot Water Heater = 7. Dishwasher &Disposal ... ,,,., „ _ 8. Clothes Dryer .....:............ .. 9. Other (specify, i.e., motors, exhaust etc.) L _ 4 ub-total - Watts V.l . . h22 pY0 lO O First 10 w tt�s�00'/0 ..... ..... ................. = 10,000 Rem ning watts @ 40'/a ...�� L%...... X75 ) 10. Air ondition er J watts..@100%.. _ �(ev`/� R-1/ oPJc::fLargest Demand = A-3OO entral Heat System L7e73/) watts @ 65`/0.. _ /3�jOQ ) Oa•9 / TOTAL DEMAND WATTS REQUIRED ............. Lai "Demand Watts Required" - 230 ............... ............ - AMPS De -rate Mobilehome to .... ............ ................. AMPS l�� evl all Ago COUNTY OF BUTTE - DEPARTMENT, OF PUBLIC WORKS 7 County Center D+rive - Oroville, California 95965 - Telephone 916/534-4541 • APPLICATIOWAND PERMIT PERMIT NO A ASSESSOR PARCEL6 NUMBER -- A,3 -- let. Z NTNG �``� BUILDING PE OW E rr '' I WIALV TELE HONE SQ. DING FT. OCC. BUILVALU TION .L. , OWNER'S MAI NG ADDRESS CONTRACTOR'S NAME p/� a TELEPHONE CO TRA S MAILING ADDRESS . 0 , '130 CONSTRUCTION LENDER J UNKNOWN Fireplace Total Valuation $ :2 -' LEND 'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ YGY BUILDING DDR SS wts _ 'PLUMBING PERMIT Filing Fee 3.00 Each Trap 2.00 Repair drainage or vent piping 2.00 Water piping LOT NO. Gb3 SUBDIVISION NAME M PARCEL MAP Each qas water heater or vent 2.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF ❑ Duplex ❑ Mobi lehome ❑ Other SPECIFY Building sewer ^ Lawn sprinkler system 2.00 TYPE OF WORK New Addition ❑ Remodel ElUtilities FI installation[] Other [:1 Describe work: — Permit Fee $ (>D ^ contractor S q- ' ELECTRICAL PERMIT Filing Fee 3.00 Main service 8000 AMP V OR ORSLESS 5.00 Main service EA. ADD'L too AMP 2.50 NEW CONST. DWELLING OP,& OR ADDNS. ACC. BLDGS.C •) 22 sq ft (e 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 Profess i s Code and my license is in full Xceland effect. License No. � Classification ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEw CONSTR ULTI-OUTL,- NON.RESID. BRANCH CIRC ITS 2.50 ea NEW CONSTR. (POWER APPARATUS &1 NON•RESID, SINGLE OUTLET CIR. / Ex. Occup(OUTLETS OR FIXTURES 13AL@C BALtOt FIXED APLINIS Ex. Occup.(OUT ETSP(RESID )REA.) 1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 6,25 Permit Fee $ Contractor TLV u Yri t .1 s4^f f U WORKMEN'S COMPENSATION INSURANCE 1 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. 1 shall not employ any person in any manner so as to become subject Y� to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT FiIingFee 3.00 Heating Cooling Hood 2.00 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 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 any 'way accrue against aid County in consequence of the granting of this permit. %� Date Sig t re of Applicant — Owner❑ Contractor ❑ Agent A SHA permit is required for excavations over 5'0" deep and demolition or construct- io of structures over 3 stories in height. Mobile Home Installation Fee $ Land Development Fee $ TOTAL PERMIT FEE f occu P. GROUP A4-1 TYPE OF CONST. V E!t HD ISSUE �, This permit is hereby issued under sions of the Butte County Code and/or work indicated above. for which DIRE R OF.PUBLIC BY PE IT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date wa —i Receipt No. .7 g 3 If WHITE-D.P.W., YELLOW-ASSESSO , PINK -INSPECTOR, GOLDENROD -APPLICANT z i ~ `l. PERMIT) NO. 4971-74P, E P 7 E M �' MH UTIL. PERMIT NO. PERMIT EXPIRES / 4f` 7, 1- �OWNER George Wallen CONTR. - _ S&N Construction, Magalia .J LOCATION (A.P. 64-23-19 ) 165 Carnegie Rd, lot 103, PP#14, Magalia 9 } .i F. s y� Temp. Power Pole / Called PG&E Temp. Elec. Serv. Called PG&E Temp. Gas Serv. Called PG&E JOB FINALED I 7��-- r COUNTY OF BUTTE — DEPARTMENT. OF PUBLIC WORKS, BUILDING INSPECTION RECORD Reinf. Steel Final Fixtures 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 out Slab Roof Sheathing Water Pi i Piers Roofing Sewer .Z Garage Fdn. Vents Fixtures Footings Garage Vents Water Htr. Stemwall Slab Prov. for physically handicapped Heaters Appliances Carport Footings Conformance of ex. - structure Gas Piping & Test Temp. Gas Slab Final Sanitation Patio FIREPLACE Final Footings Footing ELECTRICAL Reinf. Steel Final Fixtures Bond Beam FIRE SPRINKLERS Motors Framing Test Water Htr. Stucco Final Subpanels Mesh MECHANICAL Grd. Fault Prot. Scratch Heating Service o7.1 Brown Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation Permanent Door Closer Final Final DATE 9/w-) /)3 - 07 _REMARKS OR CORRECTIONS 711617r- 1/41/7, ki 617 r- v/41/,_4w �;t��a.P G �d_d �. C�6,._,> MOBILEHOME INSTALLATION INSPECTION CHECK LIST Is the mobilehome located with required separation from lot.lines and buildings and generally conform to plot plan? Yes (� No .' 1 Does the mobilehome have required clearances above ground? (Sec.5085) YesV No Are footings and supports properly sized, spaced, and braced as per approved plans? (Note P spring possible variation at s rin shackles.) (Sec. 5082 & 5083) Yes No JZIs the mobilehome level? (Sec. 5088) Yes No If more than a single unit, are crossover connections properly installed? (Sec. 5088)- Yes 088)Yes No ,&_,_�Wat r Is flexible connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes No Test - Does water piping withstand working pressure or 50 lbs. air test? Yes4 No ,,e Backflow - If coach is not State of California approved, does station have backflow device and pressure -relief valve? Yes No 7. Wastes and.Drains Is connection made with Schedule 40 DWV and have flex connectors at. each end? Yes No Does it have minimumper foot slope and is it properly supported? Yes__L No Are any leaks detected in drainage system after running 3 -gallons of water through each fixture including washing machine standpipe?',.Yes No _ 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 connected to the gas supply.with an approved " minimum obilehome connector not more than 6 ft. long? Note: All piping ' to be at least as laas the mobilehome gas line Inlet without reductions of than the mobilehome connect Yes_ No. B. Test OK as per f614Qwing procedure? Yes N 1. Open all appliance nnector valves. 2. Shut off appliance burner ilot valves. 3. Air test with'man ter to 10"-14.'-' wa column, or test with slope gauge (minimum 6oz.-maximum oz.) calibrated in tenth you increments,. Test for 10 min, without. drop. /+.Co ect gas meter to mobilehome with connector, turn on gas, t connections with soapy water. C. Are all appliance vents properly installed? Yes No 9. Elec rical Is service large enough to provide adequate amperage -to mobilehome q(must equal rating of. mobilehome with a minimum of 100 amp) and other facilities on lot, i.e., water pumps, garage, cabana,_etc.?, Yes No Is there proper clearances around panels? Yes No P --"Is power supply cord or feeder assembly properly fused? Yes -< No Is ontinuity test satisfactory as per the following procedure? Yes No De -energize electrical wiring system of the mobilehome at the pedestal. �ake sure that the power supply cord or feeder assembly conductors, including neutral conductor, have been disconnected. Switch all breakers and switches in the mobilehome to the "on" position. '1�Connect one lead of a test instrument to the mobilehome grounding conductor and apply the other lead to each mobilehome supply conductor, including neutral.. 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 andthe grounding concl.uctor. 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 o.f'the mobilehome. Upon satisfactory completion of theelectrical 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 Z q �� Length Width Z e, -'— Vehicle Serial No. State Identification No. ii�, f/. 7d �% �� . 76 J2JZ Additional. Information or Comments: COUNTY OF BUTTE — DEPARTMENT•OF PUBLIC W K 7 County Center Drive — Oroville, California 95965 (!J' Telephone: 534-4541 APPLICATION AND PERMIT !� autnonze representatives of the county of tsutte to enter upon•tne This permit is hereby issued under the applicable provisions of above-mentioned property for'inspection purposes.- the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. T.1C DIRECTOR PUBLIC WORKS A l M'k��✓Ll Date 'Signature of Permitee or Agent BDate _ 1� 71 Y Receipt No. 7 • �,_�` : � White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant ilding permit expires Date BUILDING Owner LC,6/u SQ. FT. OCC. BUILDING VALUATION - Mai I i ng Address Telephone No. '" Fireplace Contractor Total Valuation Mailing Address 140 f Permit Fee ' Plan Checking Fee&/or Penalty Telephone No. permit Fee Building Add ss �os /Cd . PLUMBING No. @ FEE PERMIT FILING FEE $3.00 64 0 3 P 44 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. No. _a 3^ / Zoning &Planning iping system 1 - 5 outlets 1.50 additional outlet .30 Fe Saft4atim Fire Dept. Fire Zone Use Permit EBuildingsewer 5.00 EQA Parking Plans Parcel Declaration Parcel Ma p 60' R/W Im rovementssprinkler p system 2.00 �_ Bldg. plans Kec'd Parce pproval PI pproval Permit Fee - $ $ NEW ❑ ADDITION ❑' UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT'FILING FEE $3.00 Main service incl. 1 meter •li� %�� -7 L 7 Additional meters, each 1.00 Sub -panel (12 or less) (more than 12) Single Family ❑ Duplex ❑ Mobil Home Others ❑ Range, Cook -top or Oven 1.00 Water Heater or Space Heater 1.00 Light fixtures balfd 23 l Receps., switches & fix outlets 25 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:.,' // ✓•,11J%eie f -i-4 rK-e5 Ln1L. Hood, Ex. Fan or F.A. Furn. Motor 1.00 Evap. cooler, gar. disp. or D.W. 1.00 Air conditioner or heat pump Water pump Mobil Home Facilities 5.00 Temp. Power Pole 5.00 License No. a Q 6 74 Classification—_6 Misc. wiring ❑ I am exempt from the Contractors License Laws of the State of California. Permit 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. QI 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 $ $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County OrdinancesTOTAL and State Laws relating to building construction, and hereby C) ,— PERMIT FEE $ U autnonze representatives of the county of tsutte to enter upon•tne This permit is hereby issued under the applicable provisions of above-mentioned property for'inspection purposes.- the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. T.1C DIRECTOR PUBLIC WORKS A l M'k��✓Ll Date 'Signature of Permitee or Agent BDate _ 1� 71 Y Receipt No. 7 • �,_�` : � White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant ilding permit expires Date 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. .� Date Signature of Permitteeee or Agent Receipt No. 1-2 /n C/v20 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 OF BLIC WORKS By Date /7-/P- 7 Bu ding permit expires Date ................. /?..-�."'�J BUILDING 1 Owner..D.P. d- ��xl 4 SQ. FT. OCC. BUILDING VALUATION Mai I i ng Address Telephone No. Fireplace Contractor X/ Total Valuation Mailing Address -� Permit Fee Plan Checking Fee&/or Penalty ,IV AI Teleph ne N . Permit Fee $ $ Building Address �� lE ��,,,_ PLUMBING No. @ FEE PERMIT FILING FEE $2.00 , Q� A09 Xz- "V///A Each Trap 1.50 10-77 le Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 A. P. No e� J �� Zo.51n P i.n. Gas piping system 1 - 5 outlets 1.50 Each additional outlet 30 Fs W San Fire Dept. Fire Zone If Use Permit Building sewer 5.00 (�v EQA Parking Plans I Parcelfarce Declaration a 60' R/W P ments Im pr ?Z Lawn sprinkler system 2.00 g. Plans Recd Parc pproval PI s Approval Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES X OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 3, Oa Main service incl. 1 meter .3i a6 Additional meters, each 1.00 Sub -panel (12 or less) (more than 12) Single Family ❑ Duplex ❑ Mobil Home Others ❑ Range, Cook -top or Oven 1.00 5%1p -5;Q- F -e— ;W. -Ar Water Heater or Space Heater 1.00 -Light ;;I fixtures p20 ol_5- Receps., switches & fix outlets 2U la) 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: Hood, Ex. Fan or F.A. Furn. Motor 1.00 Evap. cooler, gar. disp. or D.W. 1.00 Air conditioner or heat pump Water pump Mobil Home Facilities 5.00 (Ja Temp. Power Pole 5.00 > � p�1— License No. -2 6 �Z Classification /-� Misc. wiring ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ 77, D! 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. 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.1 @ I FEEPERMIT FILING FEE J$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 TOTAL PERMIT FEE $ i ! authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. .� Date Signature of Permitteeee or Agent Receipt No. 1-2 /n C/v20 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 OF BLIC WORKS By Date /7-/P- 7 Bu ding permit expires Date ................. /?..-�."'�J COUNTY OF BUTTE -,Department of Public Works 7 County Center Drive;.Oroville, California E.... PHONE: -534-4541 N !1! 3C 9 20' 1. rt K MOBILEHOME INSTALLATION rt 0 K Mobilehome Data Cis n , Plot plan dimensioned, location of mobile 1. Length 5 G Width 0 and ut • ity connections? W Yes No Vehicle Serial No.��((, `. t4 Electrical. service equipment ampacity x. 0 2. Feeder assemblyampacity ..+ .. i -0- ca- Permanent Wiring Connection Conduit size << 0 MOBILEHOME INSTALLATION INFORMATION .. Lot Facilities Mobilehome Data H :1. Plot plan dimensioned, location of mobile 1. Length 5 G Width 0 and ut • ity connections? Manuf acturer G �i}-dvL (lt' . i+ta�r-Pt � (� Yes No Vehicle Serial No.��((, 2: Electrical. service equipment ampacity Insignia Control No. p 740 l.! Circuit breaker ampacity /jam toy„ 2. Feeder assemblyampacity ..+ .. i -0- Permanent Wiring Connection Conduit size << Ampacity Power supply cord : (amp^--^�,.� - Rece tacle .. _ ..:. Am ac" P p Y 3: -Gas / ./�, _. inlet size 3. Gas:. Natural LPG— Mobilehome connector.size / -P Gas riser size Capacity �- 4: Drain inlet size 3 4. Drain connector:. describe on reverse side 5: Water riser' size '"' ""' . 3/ - 5. Water connector: describe on• � "reverse side 6: Are utility counections loca ed outside 6.. Designed loads: the rear 1./3 of the mobilehome w hin Roof live load tb sf. . 4 feet of the left wall? Yes o Wind load / sf. _ If not, shocq di.mensions.above.• (only for-mobilehomes manufactured after 7. Is the mobilehome clear of septic tank, October 7, 1973) leach fields and located ou•side public 7. Manufac rer's installation instructions? utility easements? Yes No Yes No 8. Do you propose to do other work on the 8. - ---� -- -- --- Will the mobile home be installed on a property other than the mobilehome 'ch separat support structure? installatioon w will require a permit'` Yes ?No Lam= If so, specify *For plans and specifications of support system, see other side./� ON it . w I r H ADDITIONAL C011,D1".;TS Drain Connector, Describe_ Water;- Connector, Describe_ __e n its LOAD BEARING SUPPORTS 2 /(i1 Yi7 �y LOAD BEARING SUPPORT AND VOOTING INFORMATION Pier Spacing Used Maximum Pier Load �OC� :Maximum Column Load (lw� ti -units on y) Soil Bearing Capacity OU Footing Dimension Used_ 'j( /2 TYPE OF PIED. USED Steel-4�oncrete Concrete Block Other . TYPE OF FOOTING MATERIAL USED. Pressure Treated Concrete Redwood (Grade) Other Approved Type oc? BUTTE, COUNTY BUILDING DEPARTMeNT APPROVED f07 3-/ M1wow, per SePxaliFAt,c system�t to D pt e- County Butte F L . 5 ernents. - t quit - - l (o Q�-cv= $aZ 4 EIJ:p; zV': ' 1 All utility connecti ns shall located �I b . e 3 ed within 4 ft. outside the rear third sectionthmobile 4temobi le home ...... i.. o' on the left (road) side of the mobile • r/ home. '1 ,� ,. /�� •r..', :gib 3^ ' ' � ,� �.,- d. -+- Z/C 26x5/11 .. . ° BUTTE COUNTY BUILDING DEPART(` E-1 (his set of plansA P C' 1� �/ O . +-- - r s MUST be' kept on the jeb at all times and it is unlawful to make any chances nr a►+a. :__ Coo James Glander Department of -Public Works 7 County Center Drive Oroville, California '.95965 ENGINEERING CONSULTANTS 2060 PARK AVENUE OROVILLE. CALIFORNIA 95965 PHONE (916) 599-6457 CALIFORNIA P. E. NEVADA P. E, OREGON P. E. September 8, 1975 Re: 75559 Dear Jim: Compaction .test results are enclosed for mobile home site preparation at Paradise Pines. Wallen Unit 14" Lot 103 . r Representative tests indicate that the 90% relative compaction requirement has been -,,satisfied. A location map is attached. Very truly yours, COOK ASSOCIATES A an G. Brown Civil Engineer AGB/cap Enclosure DR•. LLOYD IM. COOK ED, D. JOE E. COOK W E. - DAN J. COOK C. E. Pin Project Mallen -Paradise P b I ANUAKU LUUN I COMMENT: MOISTURE DENSITY 1384 276 9-5 SSOCIATC—S Job Number 75559 ` CG, i' ERING CONSULTANTS �uCiear ICi'PiaCe Dave Kimbrell Bye 60 PARK AVENUE O�OVILLE CA FORNM 95965 Moisture Dengest Dates at September 1975 (916) 533-6457 TEST t:UNISER 1 2 3 4 5 6 7 8 9 10 TIME .9-5 9-5 9-5 9-5 TEST Cor..: Cor. End O.G. LOCATION of of of FillFill Fill P�t00E DEPTH 8" DT 8" DT 6" DT 1811 DT MOISTURE COUNT 1674 1872 1770 1102 MOISTURE COUNT RATIO 1.209 1.352 1.278 .796 P:;OISTURE 32:75/ 37.25/ 35.00% PCF 26. 28.3 23.2 20.25 - DEI:SITY COUNT 389 432 660 777 DENSITY COUNT RATI'0 1.409 1.565 2.391-. 2.815 WET DENSITY PCP 112.5 110.0 112.5 83.50 DRY DENSITY PCF 85.5 81.7 89 63.25. % MOISTURE 31 35 26 32 OPTIMUM bENSITY PCF 95 95 95- 95 % OPTIMIUP�1 24 24 24 24 MOISTURE % RELATIVE COMPACTION 90 86 94 66 Y Date 9-4-75' AASHO T-180 #1 C ® ® _ _ ASSOCIATES TEST N0. ENGINEERING CONSULTANTS JOB NO. 75559 OROVILLE. CALIFORNIA ' MOISTURE -DENSITY CURVE ASTM D1557 A Test #1 #2 #3 #4 Mold + B Soil Grams 3520 3730 3798' 3775 Mold C Grams 2023' 2023 2023 2023 Net Soil D Grams 1497 1707 1775 1752 Mold E Size 1/30 1/30 1/30 1/30 Unit Wt. F L b s./ft. 3 Wet 99.0 112..9 117.4 115.9 G Pan Number 1,41. 1000 .1051 lA Pan + H Sample Wet 338 839 502. .571 Pan + I Sample Dry .291 747 426 473 Pan J Grams 102' 320 111 124. K Speedy M. C. . 19.7 .19..9 22.8 25.3 ' L % Moisture 24.9 21.5 24.1 28.0 Unit Wt. M Lbs./ft. 3 Dry . 79 93 95 91 By Alan Brown D= B C F_ D x E 453.6 L r= H - 1 x 100 .. M= F J L Client Name and Address George. R. Wallen 165 Carnegie Road, Paradise Job LocationMobile Home Site Material Source Native, — Red Silt Clay , LOC47100; R&R41)15S P WSi:) 1'(05 G�21..IEC�I E R.oG� � W Z �y a • PERMIT NO. 2768-82B PERMIT EXPIRES— 61 �'A— e Georg Wallen W OWNER CONTR. Sierra Const,Paradise ASSESSOR PARCEL 64-23-19 LOCATION '�arnegie Rd, Magalia Z N ZZ& A /A .Temp. Power Pole— Called PG&E Temp. Elec. Service Called PG&E — Temp.'Gas Service CalledPG&E— JOB FINALED (Dat( A /A J = OK 0 = Not OK —=:NotAppl�cable MOBILEHOMES Not Ready MISCELLANEOUS Date MOBILEHOME UTILITIES (Plans) OK except N's Date DECK COVERS, CARPORTS, ETC. (Plans) OK except N's 1. Zoning Requirements—Setbacks—Easements fXZop4g Requirements—Setbacks—Easements 2. Soils; Special MH Support—Sketch o ' gs; Size—Depth—Spacing—Connectors 3. Sewer; Location—Test—Fall-C/0—Concrete ecks; Girders and/or'Joists—Decking—Bracing—Stairs—Rails 4. Water; Location—Test-Easement Needed (Sketch) 4. Wood Awn.; Posts—Beams—Rftrs.—Connec.—Shthg.—Rfg.—Bracing 5. Electricity; Location—Clearances—Grnd.—/ / Amp—Concrete 5.AA>-. Awn.; Columns—Connections—Splice—Decal—Enclosures 6. Gas; Location—Test—Wrap:/ /"L" ft./ /"Nat. or/ /"L" ft./ /"LPG Carports; Windows—Doors 7. Utility Clearance 7. Elec. rr,� Card -BI Card -BI Date Card -BI Date Date Card -BI Date Card -BI Card -BT ate Card -BI Date _ ate,/ Card Date Date MOBILEHOME INSTALLATION (Plans) OK except N's 1, Zoning Requirements—Setbacks—Easements Date If POOLS (Plans) OK &xdept N's 1. Setbacks—Easements 2. Footings; Size—Spacing—Marriage Line 2. Soils; Compaction—Structure Stability 3. Gas; MH Test—Demand—Valve—Connector 3. Pool Structure; Steel—Connections—Thickness—Dead Men—Lining 4. Electricity; MH Test—Crossovers—Breakers—Clearances 4. Elec.; Receptacles and Lighting; Distances—GFI 5. Drain; MH Test—Fall—Flex Connector 6. Water; MH Test—Regulator—Connector 5. Elec.; Pool Lighting; 15 volts—GFI 6. Elec.; Enclosures; Conduit Entries—Terminals—Listed 7. Water and Sewer Connected—C/0 to Grade—HD Approval 7, Elec.; Bonding; Metal w/5'—Circulating Equipment—Heater 8. Gas and Electricity Tagged 8. Elec.; Grounding; Equip. w/5'—Circulating Equip.—Pool Lghtg. Boxes—Enclosures—Panel boards—Ins. to Main in Conduit 9. Exits; Insp.—Sketch 10. Cert. of Occupancy 9, Health Department Approval 10. Plumb; Cir. Test—Water Supply Test Card B -I Date Card -BI Date Card -BI Date Card -BI Date Card B -I Date Card -BI Date Card -BI Date Card -BI Date a V J = OK 0 = Not OK - = Not Applicable RESIDENTIAL'(Sing,le and Duplex) **= Not Ready Date UNDERFLOOR (Plans) OK except N's 1. Zoning requirements -Setbacks -Easements 2. Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Dept 3. Ftg., Garage; Soils -Steel- / /" Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth _ 5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab 6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab 7. Piers -Fireplace Ftg.-Steel 8. D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test 9. Gas Pipe; Size -Anchors 10. Water Pipe; Test -Anchors -Regulator -Service Test 11. Electric; Underground 12. Plenums & Ducts; Clearance -Material -Support -Ins. 13. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date PLUMBING (Permit) OK except p's 14. Water Ht.; Vent -Access -Combustion Air 15. Water Pipe; Test & Anchors -Nail Protection 16. D.W.V.; Test-Fttngs & Anchors -Nail Protection 17. Shower Pan; Test, First Floor -Tub Access _ 18. Test Tub & Shower, 2nd Floor -Tub Access 19. Gas Pipe; Size & Anchors 23. Romex Installed Close to Edge of Studs & C.J. 24. Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date ELECTRICAL (Permit) OK except q's 20. Fixture & Transformer Clearance -Ins. Protection 21. Elec. Receptacles Spacing -Lights & Switches at Doors 22. Size Boxes & No. of Conductors -Stapled 23. Romex Installed Close to Edge of Studs & C.J. 24. Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water 25. 2 Appliance Circuits in Kitchen & Conductor Size 26. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or A 27. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or At, Insulated Neutral rYes ❑No 28. Service -Riser Conductors & Ground -Main Disconnect 29. Equip. Clearances; Panels-Motors-Mech. Equip. 30. Clothes Closet Light -Shower Liqht Card B -I FRAMING (Continued) ' Date Card -BI Date Card B -I Date Date Card -BI Date MECHANICAL (Perm,it) OK except q's 31. A.C. Ducts; Insulation & Support 32. Vent Fan; Exhaust above Insulation 33. Condensate Drain & Overflow; Size & Grade _ 34. Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet 35. Attic Access -& Platform if Furnace in Attic 54. Glazing Area -Glass Protection -Skylights -Plastic Card -BI Card -BI 55. Date _ Card -BI Date Date Card -BI Date Date FRAMING(Plans) OK except N's 36. Sills; Proper Material & Anchors 37. 38. 39. Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound Bearing Walls over Girders & Floor Nailing Draft Stop in Walls (rat proof) 40. Fire Stops; Furred Ceilings -Stairs -Chases -Tub 41. 42. 43. 44. Header & Beam -Size & Bearing_ Hangers -Post Caps -Anchors -Connectors Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng. Fireplace Ties or Type A Flue -Fireplace Throat _ 45. 46. 47. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions Garage Fire Protection Framing Date FRAMING (Continued) ' 48. Property Line Firewall & Openings 49. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits 50. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 51. 52. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers Siding -Nailing -Veneer 53. Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access 54. Glazing Area -Glass Protection -Skylights -Plastic 55. Shear Walls; Nailing -Bolts Card -BI Card -BI Card -BI Date Card -BI Date Date Card -BI Date Date Card -BI Date Date FINAL (Plans) OK except k's 56. Ext. Steps -Door & Sidelight Protection -Landings 57. 58. Smoke Detector Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 59. Bedroom Exiting 60. G.F.I. & Bath Fixtures & Tub Access 61, Elec. Trim & Subpanel; Breaker Sizes -Labels 62. Stairs & Rails 63. Fireplace or Stove; Clearances -Hearth 64. Elec. Outlets at Wood Panel; Int. & Ext. 65. Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance 66. Elec. Outlets & Receptacles at Kit. Counter 67. Garage Fire Door; Swing -Landing -Closer 68. A.C. Duct in Garage -Damper 69. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.- In Garage; Above Floor-Mech. Protection 70. Plb., Elec. & Mech. Equip. Listed for Location 71. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec. 72. Insulation -Foam -Looked in Attic ❑Yes 73. Guard Rails & Deck Construction -Post Caps 74. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 75. Following instld.: Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No; Planters El Yes El No 76. Stucco; Brown -Finish 77. A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet 78. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs. 79. Water Well; Disconnect, Electrical, Plumbing 80. Exterior Elec. Trim; G.F.I. Receptacle -Underground 81. Ventilation throughout House 82. Glass Protection 83. Corrections from Previous Inspections 84. Gas Test -Meters Tagged; Gas -Electric 85. Water & Sewer Connected -C/O to Grade -HD Approval 86. Energy Compliance Certificate -Other Certificates Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Comments at Final: (NOTE:Anentrymust be made each time youvisit jobsite) COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Orov)"pf Cal+for(1ia 95965 - Telephone 916/53,4Z5141 I APPLI�OJWN AISD PERMIT � ��lJ PERMIT N / '- Z-- All ASSESSOR PARCZONINGL NUMBER ZONING ( BUILDING PERMIT O WNETELEPHONE c v I i' LEr i �J SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESSS AD CONTRA, OR'S NAME iE�ii"�� TELEPHONE CONTRACTOR'S MAILING ADDRESS Q Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is O� Filing Fee $ 10.00 • LENDER'S MAILING ADDRE Permit Fee $ ,Up ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee .$ , Penalty $ ARCHITECT OR ENGINEER'S AILING ADDRESS Permit fee $ 49U BUILDING ADDRESS • PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Repair drainage or vent piping 5.00 Water piping LOT NO. j SUBDIVISION NA"P [ P ' PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome� Other SPECIFY Building sewer Lawn sprinkler system 5.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe work: za, `T SC;aF-- &J F."RCIA aye -a- vLESS ;-Ja ,..'yC�F �,� ,� �/ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 00V OR Main service 1100 AMP ORS 5.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. (DWELLING OCCUP.y\ OR ACDNS. ACC. BLDGS. _ I 2¢ sq ft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): l am licensed under provisions of Chapt. 9, Div. 3 of the Business Professions Code and m license is in full force and effect. License No. Classification R ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONSTR '-OUTLET 2,50 ea NON. CIRC ITS NEW CONSTR POWER APPARATUS &) NON.RESID, SINGLE OUTLET ,IR. Ex. Occup OUTLETS OR FIXTURES a �@1 and IXED APPLNS. OR EX. OCcup.(OUTLETS (RESID.) EA. 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 7.50 Permit Fee $ Contractor MECHANICAL PERMIT FiIingFee 10.00 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ 1 have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Heating Cooling Hood 3.00 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 County of 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 again said 'unty in consequence of the granting of this permit. X _ Date q— /6— S�` Signature of Applicant — Owner ❑ Contractor Y3 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 $ TOTAL PERMIT FEE $ OCCUP. GROUP M_� TYPE OF co ST. PA PD ND Iss This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECT OF PUBLIC By PE IT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Dateq—Li-�p 2j- ( Z"i—p _] [Receipt No. L� �� l TE-D.P.W., YELLOW -ASSESSOR, PINK-INSPE TOR• GOLDENROD -APPLICANT N C. � QFfM ATTACHMI.NT �b ---- --- I Aerm 14 oro"dr JA 10 Wei eL.yf A 1. 940MIWOM V& M -v AfA 1#4 rot. PA .44,01—vMt /It I e4-060 Ir VJe AMc*,Y6f,4K Im 0,,, Af4K agr 4,vy A,,Oyve J,ejj4 Ale poo'! 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