HomeMy WebLinkAbout064-260-00664$a J� 7
Donald Conklin ' /
40 Odessa ., of 148 P 1#15, Magalia
c ontr : Tri V Const. ,. P��' radise
Permit jk17 6- 7P,E(uti1�MH)
ELEC.��
GAS —
SUPPORT_ T U T764:-.--
Q.
e j' �
COMPACTION TES��
— – _ -26-6
contr: Kentwood, -Mobile ome Salws,Chi
Permit #2426-77MHI L
issued' .T--.�/7�77
64-24-6
contr: Lloyd.Roberts', Paradise
Permit #3016-77B(new open deck & pri.
garage/MH)
� � �y �
�-� I
r
3016-77B
r04ERMIT NO. X'
PERMIT EXPIRES ' 4A ,Z2e
OWNER Don Conklin
'CONTR. Lloyd R. Roberts, Paradise
LOCATION (A.P. 64-26-6
40 Odessa Ct., lot 148, PP#15, Magalia
Temp. Power Pole
Called PG&E
Temp. Elea Serv.
Called PG&E
Temp. Gas Serv.
Called PG&E
FOI ALED_ 7- T J
(Date)
(Signatur
COUNTY OF BUTTE — DEPARTMEJ4T OF PUBLIC WORKS
BUILDING INSPECTIO'N'RECDRD
BUILDING
BUILDING (Cont'd)
PLUMBING
Setback �1
Firewall
Soil Piping
Forms �'
Parapets
1st Floor
Main Bldg.,
Restroom Finish
2nd Floor
Footings f'✓
Windows
3rd Floor
StemwalI
Siding
To out
Slab
Roof Sheathing
Water Piping
Piers
Roofing
Sewer
Garage
Fdn. Vents
Fixtures
Footings
Stemwa I I
Garage Vents
Insulation
Water Htr.
Heaters
Slab
Carport
Footings
Prov. for physically
handica e.
Conformance of ex.
structure
A liances
Gas Piping & Test
Temp. Gas
Slab
Final
Sanitation
Patio
FIREPLA
Final
Footings
Footing
ELECTRICAL
Masonry Walls
Throat
Rou h
Reinf. Steel
Final
Fixtures
Bond Beam
FIRE SPRINKLERS
Motors
Framing
Test
Water Htr.
Stucco
Final
Subpanels
Mesh
MECHANICAL
Grd. Fault Prot.
Scratch
Heatina
Service
Brown
Cooling
Temp. Pole
Finish
Ducts
Underground
Interior Lath
Ventilation
Permanent
Door Closer
Final
Final
MOBILEHOME UTILITIES ------------------Elec. Service
Elec_ Pedestal
Water Piping
Sewer
Gas Piping
MO8ILEtJ2ME INSTALLATION - - - - - - - - - - - - - - Support
Elec. Continuity
Water Piping
Drainage
Gas Piping
DATE
REMARKS OR CORRECTIONS
(NOTE: An entry must be made on this form each time you visit the job site.)
t_ r COUNTY OF R-UTTE•, — DEPARTMENT OF11PUBLIC WORKS
7•County Cenier Drivq — (3roville, California 95965
i
Tel ephone��I34-4541 /_
� (p
APPLICATION AND PERMITN y1
authorize representatives of the County of Butte to enter upon the
above-mentioned pro erty ins p do p oses.
29 Date Cf� o`O
g Lure of Permitee or Agent
Receipt No.
�Z
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 0'-F)PUBLIC WORKS
By Date
B 'ding permit expires Date 6'z�'
BUILDING
Owner "Pow F CO
SQ. FT. OCC. B ILDING VALUATION
a
Mailing Address
c2go (D 13
Telephone No.
Fireplace
Contractor�`(� /.K��ieTs'
Total Valuation
Mailing Address D 0 Ot^a
Permit Fee
Plan Checking Fee &/or Penalty
Telephone No.
Building Address
Permit Fee $
7
PLUMBING No. @ FEE
PERMIT FILING FEE $3.00
LO �C —K
Each Trap 1.50
'
Repair drainage or vent piping 1.50
Water piping 1.50
oe
Each gas water heater or vent 1.50
A. P. No. Gj '' tit'
Zoning & Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
F
W16,
Sa10/pn ire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
Parking arcel
Plans Declaration
Parcel Ma p
60' R/W
Im rov ments
p
Lawd sprinkler system 2.00
Bldg. P s Recd
Parce roval
PI s Approval
Permit Fee $
$
NEW ADDITION ❑ UTILITIES ❑ OTHER ❑
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
Main service 600V OR LESS 5.00
100 AMP OR LESS
Main service EA. ADD'L 100 AMP 2.50
Main service OVER 600V 25.00
100 AMP OR LESS
Single Family ❑ Duplex ❑ Mobil Home Others
Main service EA. ADD'L 100 AMP 1.00
NEW OR ADDNST ( ACCLB DGLING OCCUP. &65- ) 2¢sgft
NEW NON-RESID R. ( BRANCH CIRCUITS) 12.50ea
NEW CONSTR. (POWER APPARATUS &
NON-RESID, SINGLE OUTLET CIR.
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
G�QPZ_y� 2 /C� ���
Ex. OCCUP(OUTLETS OR FIXTURES) 50 BAL2j
FIXED APLNS.
Ex. Occup. ( OUTLETS P(RESID )REA) 2.00
Temporary service 10.00
D� enf�r/�,•,ry ��n��s�I ��
/2 lJ;/
Mobile Home Facilities 15.00
License ,ifi
License No{�1���% Classification
Misc. Wiring 6.25
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
MECHANICAL No. @ FEE
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
en's Compensation.
forrio.��,�
e placedon file with the County of Butte a certificate of
omen'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.
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and' -,State Laws relating to building construction, and hereby
TOTAL PERMIT FEE
$ p? —
authorize representatives of the County of Butte to enter upon the
above-mentioned pro erty ins p do p oses.
29 Date Cf� o`O
g Lure of Permitee or Agent
Receipt No.
�Z
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 0'-F)PUBLIC WORKS
By Date
B 'ding permit expires Date 6'z�'
PERMIT NO. 1766-77P ,E
PERMIT EXPIRES
OWNER Donald Conklin
CONTR. Tri -V Const., Paradise
LOCATION (A. P. 64-26-6 )
" 40 Odessa Ct ., lot 148, PP#15, Magal is
.4
Temp. Power Pole
Called PG&E
Temp. Elec. Serv. —7?
260/
Called PG&E
Temp. Gas Serv.
Called PG&E
AZINALED
(Date)
(Signature)
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE
OROVILLE, CALIF. - 534-4541
CERTIFICATE OF OCCUPANCY
This mobilehome has been installed in accordance with the requirements
of the California Administrative Code, Title 25, Chapter 5, under permit
7
number ; L for the following location:
Owner
Owner's Address
Mobilehome Mfg. Model - Year r
Insignia No. ? Serial No.
It is hereby certified for occupancy at the above described location and
may be occupied.
Director of Public Works
Date % By
THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED
Set ack
Form
Mal Bldg.
Fo in s
ti Stem alI
Slab
Piers
Garage
Footings
Stemwa I I
Slab
Carport
Footings
Slab
Patio
Footings
Masonry Walls
Relnf. Steel
Mesh
oor Closer
- MOBILEHOP
Water Piping
OBILEHOF
Water Piping
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
W
BUILDING INSPECTION RECORD
BUILDING BUILDING-(Cont'd)
-• FI wall
S I Piping
Par ets
1 t Floor
Restr om Finish
2n Floor
Window
3rd oor
Sidin
To out
Roof Shea In
Water PI i
Roofing
Sewer
Fdn. Vents
Fixtures
Garage Vents
Insulation
Water Htr.
Heaters
Prov. for ph sical
handicaped
Conformance of ex.
structure
Appliances
Gas Piping8
Temp. Gas
Final A
Sanitation
REP ACE
Final
Footing
F
entilation
final
Elec. Service
Sewer
ION --- ----------- Support
Drainage
MECHANICAL
j DATE REMARKS OR CORRECTIONS
r
Fixtures
Motors
Water Htr.
Sub anel
Grd. Fa t Prot.
Servic
TyAp. Pole
nderaround
PLUMBING
Final
Elec. Pedestal ,.5'-J-7-1?
Gas Piping
Elec. Continuity \
Gas Piping
(NOTE: An entry must be made on this form each time you visit the job site.)
ii0}3li,l?IiU:tG U611ALLA'QON INSPECTION CHECK LIST
located wi.�. � .
1. Is the. mobilehome l required separation from lot lines and buildings and generally
conform to plot plan? Yes i%No
?, Doe; the mobilehome have requir(,-A clearances above ground? (Sec.5085) Yes '-'�No
3. Are footin,s and supports properly sized, spaced, and braced as per approved plans? (Note
possible variation at spring shackles.) (Sec. 5082 & 5083) Yes �No
4. Is the mobilehome level.? (Sec. 5088) Yes No
5. If muse. than a single unit, are crossover connections properly installed? (Sec. 5088)
Yes No
5. Water
A. Is flexible connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566)
Yes ✓No
B. Test - Does water piping withstand working pressure or 50 lbs, air test? Yes L -"'No
C. Backflow - If coach is not State of California approved, does station have backflow device
and pressure -relief valve? Yes No
7. Wastes and Drains
A. Is connection. made with Schedule 40 DWV and have flex connectors at each end? Yes / No
B. Does it have minimum z;" per foot slope and is it properly supported? Yes �No
C. Are any leaks detected in drainage system after running 3- allons of water through each
fixture including washing machine standpipe? Yes No
D. If coach is not State of California approved, does station have required trap and vent?
Yes No
8. Gas Piping and Gas Vents
A. Connector - Is mobilehome connected to the gas supply with an approved 3/4" minimum
mobilehome connector not more than 6 ft, long? Note: All piping is to be at least as
large as the mobilehome gas line inlet without reductions other than the mobilehome
connector. Yes No
B. Test OK as per following procedure? Yes 1--l"No
1. Open all appliance connector valves. `
2. Shut off appliance burner and pilot valves.
3. Air test with manometer to 10"-14" water column, or test with slope gauge (minimum
6oz.-maximum 8 oz.) calibrated in tenth pound increments. Test for 10 min. without
drop.
4. Connect: gas meter to mobilehome with connector, turn. on gas, test connections with
soapy water.
C. Are all appliance vents properly installed? Yes L_�No
r
9. Electrical ,
A. Is seivice large enoi.iglt to provide adequar_e amperage to mobilehome (must equal rating of
mobilehome faith a. ::;invi:um of 100 amp) and other faciliti_t.s on lot, i.e., water pumps,
,,arag,e, cabana, ctc.? Yes -" No
B. Is ther,a proper clearances around panels? Yes —No_
C. Is power supply cord or feeder assembly properly fused? Yes ✓No_
D. Is continuity test satisfactory as per the following procedure? Yes_ No_
1. De: -energize 'electrical wiring syste:ii of the mobilehome at the pedestal.
2. Make sure that the power supply cord or feeder assembly conductors, including neutral
conductor, have been disconnected,
3. Switch all breakers and switches in the mobilehome to the "on" position.
4. Connect one T::.ad of a test instrument to the mobilehome grounding conductor and
apply tLiC oLher a.uau to each ni.�
uuieiiiiiiit supply Cunuucto'i , illi Tiiuttig ileal rdl.
5. All nor. -current, carrying metal parts of the mobilehome (aluminum siding, gas line,
water line), including fixtures and appliances, shall be tested for continuity from
such equipment and the grounding conductor.
6. Upon com.pleticn of the above procedure, the power supply cord or feeder assembly
conductors shall. be connected to the site service equipment. A further continuity
te::;l shall then be made between L:.he ,grounding electrode and the chassis of the
ciobilehome. Upon satisfactory completion of the electrical tests, the lot or site
service equipment may be approved for energizing.
.; teIs job card si-ned by health Department for water and sanitation?
1.1. If everything okay, sign off card and to services.
'MUEiILLiIUt^E DATA
Manufacturer and/or Namest.yle
Length 40--- Width �– —
vehicle Serial No. e� l t
State Identif.icati..on No.
deii.tional Information or Comments:
.•—
CvQUN`fY OF BUTTE`} DEPARTMENT OF PUBLIC WORKS
7 County Center Drive Oroville, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
/��177
authori r resentatives of the County of Butte to enter upon the
abov men ed property for inspection purposes.
X��00�Date �l 7 7
ignatureoff Permitee Agent
Receipt No. j l`� 072�
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 RUBLIC WORKS
By Date y—� 1-22
Bf(ding permit expires Date y 2(-7
BUILDING ell
Owner��iJVYA
SQ. FT. OCC. BUILDING VALUATION
Mailing Address
Telephone No.
Fireplace
Contractor �Q� �— CE.J,r�T
Total Valuation
Mailing Address (olss, e�.^ 4,t/ -
Permit Fee
Plan Checking Fee &/or Penalty
✓adiS t �A . — L
T ephone No.
7 7 3.11-0
Permit Fee $
Building Address
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00 ,
Z/0 Q & �5
Each Trap 1.50
(9T , �� & ;hf��•
Repair drainage or vent piping 1.50
Water piping 0
4LI Univa Varificatian Only
Each gas water heater or vent 1.50
//,*14
A. P. No. 67 41-a—
/� Z—
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
Fe
iv
a o ire Dept.
Fire Zone
Use Permit
Building sewer _.&W D'
EQA
Parking Parcel
Plans Declaration
Par I Ma p
60' R/W
Improvements
p
Lawn sprinkler system 2.00
BI (EQS `ec'd
arcel Approval
Plon proval
Permit Fee $ 2-3$
a3 Or%
NEW ❑ ADDITION ❑ UTILITIESJV OTHER E]ELECTRICAL
No. @ FEE
PERMIT FILING FEE $3.00
Main service 100 AMP OR01 OR L LESS5.00
Main service EA. ADD'L 100 AMP 2.50
Main service OVER 600V100 AMP OR LESS 25.00
Single Family ❑ Duplex ❑ Mobil Home tu Others ❑
Main service EA. ADD'L 100 AMP 1.00
SQ 9 MINIMUM
NEW
OR ADDNST ( DWEACCL BLDGS.LING CCUP. &\ 20 sq ft
/
NEW CONSTR. MULTI -OUTLET
NON-RESID. ( BRANCH CIRCUITS) 2.50ea
FOR MOBILES
POWER NONNEW RESID. (SINGLE OUTTLETTUS CIR.&
.ESI D.
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:
/K/ — ✓� �o� S%- �Q
Ex. Occup(OUTLETS OR FIXTURES) BAL@@1
TS(RESID)REA) 2.00
Ex. Occup. (0UT EP
Temporary service 10.00
Mobile Home Facilities
License No.-, Classification
Misc. Wiring 6.25
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $ `jos✓
$ Z "`
MECHANICAL No. @ FEE
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑1 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.
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
1 certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State, -aws relatinq to buildinq construction, and hereby
tow
TOTAL PERMIT FEE
$ 3 S'O
authori r resentatives of the County of Butte to enter upon the
abov men ed property for inspection purposes.
X��00�Date �l 7 7
ignatureoff Permitee Agent
Receipt No. j l`� 072�
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 RUBLIC WORKS
By Date y—� 1-22
Bf(ding permit expires Date y 2(-7
MOBILEHOME- SUPPORT DATA
Mobilehome Mfr:�C¢. c�/ Setup Model o C%
p N _ � Year
Width .(ft.) Length (ft,) • Expando' Size ft.x ft.
(Draw support details below)
On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation
manual and structural setup sheets (if not on file with the County of Butte).
�in.
(ft. in.')
I
d
P-3k.'-f(in.)
(in.) (in.)
a -,7
*If center piers are other than drawn above,
draw in locations, spacing, and dimensions.
Footings (check one)
% %1. Wood either
pressure treated or
fdn. grade.
2. Concrete pad.
3. Other, specify
Supports (check one)
/-`1. Concrete block
2. Concrete piers
3. Steel piers
4. Other, specify
Typical Support
1x3 U � Footing Size
�)T -H )
Max. Pier
J Spacing
(ft.)(lin.)
Max.
Overhang
BUTTE COUNTY
BUILDING MPARTNIENT
APPROVED
Center
Center Support
Support'
Footing Sizes
Locations
(in.)
(in.)
Cfb-Y(
(ft) Zin)
(in.)(in.)
�in.
(ft. in.')
I
d
P-3k.'-f(in.)
(in.) (in.)
a -,7
*If center piers are other than drawn above,
draw in locations, spacing, and dimensions.
Footings (check one)
% %1. Wood either
pressure treated or
fdn. grade.
2. Concrete pad.
3. Other, specify
Supports (check one)
/-`1. Concrete block
2. Concrete piers
3. Steel piers
4. Other, specify
Typical Support
1x3 U � Footing Size
�)T -H )
Max. Pier
J Spacing
(ft.)(lin.)
Max.
Overhang
BUTTE COUNTY
BUILDING MPARTNIENT
APPROVED
BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS
7 County Center Drive, Oroville, CA.
PHONE: 534-4541
MOBILEHOME INSTALLATION SHEET
siteservice?
---------------------------------------------------
Yes / /
No
0 GC �.
(If yes, identify the load and size:
(Load)
(Amps)
1.
Owner's name:
is the mobilehome site gas pipe size? ----------------------
(in.)
` 2.
Installer's name: e-,,, rx
is the type of gas service? -----------------------------
LPG
ll.
What
is the gas pipe length from meter or tank to
the mobilehome?
(ft.)
3.
Is the site currently under permit? Yes / /-
No
(BTU)
.(If yes, furnish permit number / % ) OR
(This information not required if pipe length
less than 6 ft. on natural
gas
Is the site an existing site? Yes / /
No / 21�
or less than 50 ft. on LPG.)
(If yes, furnish two (2) plot plans.)
4.
Will the mobilehome be located at least 5 ft_. away from septic tank
and leach fields
and
clear of all setbacks and easements? Yes
No
( If no, clarify
)
3
(
)
5.
What is the mobilehome electrical rating? -----------------------
s
6.
What is the mobilehome site service rating? ---------------------
Amps
7.
What is the mobilehome site circuit breaker rating?
-------------
Amps
8.
Is there any other electric load to be served by the
mobilehome
siteservice?
---------------------------------------------------
Yes / /
No
(If yes, identify the load and size:
(Load)
(Amps)
9.
What
is the mobilehome site gas pipe size? ----------------------
(in.)
10.
What
is the type of gas service? -----------------------------
Natural / /
LPG
ll.
What
is the gas pipe length from meter or tank to
the mobilehome?
(ft.)
12.
What
is the mobilehome gas demand? ------------------------------
(BTU)
(This information not required if pipe length
less than 6 ft. on natural
gas
or less than 50 ft. on LPG.)
MH UTIL. CLEARED -o® DATE
ggF,f1CiISd TION
I°Oo
N0SUPPORTRT CO AC
STiUCo TET t
°FMi c t
S AAAA
I -? Gl
1
y 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 inspec ion purposes.
X lk Date
Signi.ture
�ofPermriteeee or Agent
Receipt No. / ( Z !&
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/RUBLIC WORKS
By Date v- ?%
S 7�
E;� �ilng permit expires Date ��O—
BUILDING
Owner CcJ`%) y—I
SQ. FT. OCC. BUILDING VALUATION
Mailing Address
Telephone No.
Fireplace
Contractor
Total Valuation
Mailing Address Y1
Permit Fee
Plan Checking Fee &/or Penalty
CTelep
��j e�s�3 .
Permit Fee $
Building Address
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00
grag
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. ' o./
Zoning 8 Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
F(/es I
W16-1.
95"t't0trM
Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
Parking
Plans
Parcel
Declaration
Parcel Ma p
60' R/W
Im rovements
p
Lawn sprinkler system 2.00
Bld ane Recd I
Parcel Approval I
Plans Approval
Permit Fee $
$
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
1/35 AU*_766-..-
Main service 100V OR LESS 5,00
100 AMP OR LESS
Main service EA: ADD'L 100 AMP 2.50
Main service OVER 600V 25.00
100 AMP OR LESS
Single Family ❑ Duplex ❑ Mobil Home 1M Others ❑
Main service EA. ADO'L 100 AMP 1.00
NEW CONST. OWEL-ING
OR ADDNS. ( ACCLBLDGS.CCUP. &) 20.sgft
NEW CONSTR. MULTI -OUTLET
NON.RESID. ( BRANCH CIRCUITS) 2.50ea
NEW CONSTR. POWER APPARATUS &)
NON.RESI D. (SINGLE OUTLET CIR.
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
�Ex.
style of: }� wwke_
t&iL(50id 1/li� J �"
Ex. Occup(OUTLETS OR FIXTURES) BAL@1
FIXED ALNS.
QCCUp.(0UTLETSP(RESID )KEA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. 2 '>,5— 1,Q �.Classification /
Misc. Wiring :]:6:2::5:�`
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
MECHANICAL No. @ FEE
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for IN en's Compensation.
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.
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
�A
-'/
TOTAL PERMIT FEE
$
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspec ion purposes.
X lk Date
Signi.ture
�ofPermriteeee or Agent
Receipt No. / ( Z !&
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/RUBLIC WORKS
By Date v- ?%
S 7�
E;� �ilng permit expires Date ��O—
COUNTY Or BUTTE
DEPT. Or PUBLIC WORKS
MAY 18 1977
14M41.1
J,
a