HomeMy WebLinkAbout064-260-01964-26=19
Neal Assante
30 Joplin Ct., lot 163, PP#15, Magali,
Permit #4399-78P,E(ut r1.,MH)
ELEC . /�sole
GAS 0
SUPPO RUCTURE REQ. Z�
"OMPACTIQN TEST REQ. '-fta
64-26-19
> Contr:'Paradise Modular -Concept
Permit #5398-78MHI
Issued
y/i6;4; 7 V19
contr: Holmes Mobile Home Serv., Oro.,<
Permit #3095-79B(new awning/MH)
064-260-019 99-2653
AsSANTE, AGNELLO & LORENE
6218 JOPLIN COURT, MAGALIA ,
CONTR: SIERRA MOBILE
MH ON PERM FND, EX S
064-260-019 00-0378
DRENNAN, GENE x1" -(-
6218
6218 JOPLIN CR, MAGALIA
CONTR: SUBURBAN PROPANE
GAS LINE FOR HVAC
064-260-019 04-0886
DRENNAN
6218 JOPLIN CT, MAGALIA
Cont: OWNER
MOVE ELEC SERV
Ex iCtd Wi+OU} i C*0-A .
064-260-019 05-2367
DRENNAN, GENE & AL^�A
6218 JOPLIN CT, D
Cont: OWNER
ELEC SERV
N
,i i
mo
NOTES
T
t�!a
RESIDENTIAL
064-260-019 99-2653
PERMIT No* -
ASSANTE; AGNELL;O & LORENE" ` -
621 H JOPLIN COURT, MAGALIA
CONTR: SIERRA MOBILE
MH ON PERM FND, EX SITE
I
SPECIAL CONDITIONS
CHECKED
BY
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
JOB FINALED (Date) 00. y
Signature
✓ = OK,
0 = Not OK
- = Not Applicable
= Not Ready
MOBILE HOMES
Date
MOBILE HOME UTILITIES (Plans) OK except #'s
5.
1.
Zoning Requirements -Setbacks -Easements
6.
2.
Soils; Special MH Support Sketch
7.
3.
Sewer; Location -Test -Fall -C/O -Concrete
8.
4.
Water; Location -Test -Easement Needed (Sketch)
9.
5.
Electricity; Location-Clearances-Grnd-/ /Amp -Concrete
10.
6.
Gas; Location -Test -Wrap;-/ /" L 'ft.
/ s '/'Nat. or/ /"L"ft./ PLPG
7. Well Clearance & Disconnect
8. Utilitv Clearance
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date MOBILE HOME INSTALLATION (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
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 -Connector
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
U. Permanent Foundation Only; License Decal
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 #'s
1 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- Bea ms- Rftrs.-Con nectors
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
a
12.
Braced Wall Panels
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FINAL (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
1
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 in Conduit
9.
Health Department Approval
10.
Plumb.; Cir. Test -Water Supply Test
11.
Light Niche
Date
Card B-1 Date Card 8-1
Date
Card B-1 Date Card B-1
V= CK
0 = 'Not OK
= Not Applicable
Not Ready RESIDENTIAL (Single & Duplex)
=- "
Date Underfloor (Plans) OK except #'s Date FF°.WAINC 'Contir. 2•1
1. Zoning -Setbacks -Easements -Flood -Slope 46. Hangers -Post rips -Anchors-( iectors
2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 47. Cling. Joist-Rftr. Ties- Purlin-Foff Brac.-Truss-Shting.-Rfng.
3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ P Ftg. Depth 48. Fireplace Ties or Tvoe A Flue -Fireplace Throat Clearance
4. Fig., Porches & Decks; Soils -Steel-/ /" 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
49.
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
Date
50.
Card B-1 Date Card B-1
Date
51.
52.
Card B-1 Date Card B-1
Date
53.
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
22.
Gas Pipe; Sixe & Anchors
60.
Brace Interior/Exterior Wall Panels
Date
61.
Card B-1 Date Card B-1
Data
62.
Card B-1 Date Card B-1
Date
ELECTRICAL (Permit) OK except #'s
U...
23.
Fixture & Transformer Clearance -Ins. Protection
Date
24.
Elec. Receptacles Spacing -Lights & Switches at Doors
"ate
25.
Size Boxes & No. of Conductors Stapled
26.
Romex Installed Close to Edge of Studs & C.J.
27.
Equip. Ground made up w/Meth Fasteners -Bond Gas & Water
28.
2 Appliance Circuits in Kitchen & Conductor Size GFI
29.
Subfeed Wire Size / / ga. Cu or-Al-A.C. Wire Size / / ga Cu or Al
30.
Range Circle / / ga Cu or AI -Oven Circ. / / ga Cu or At
Insulated Neutral ❑ Yes Q No
31.
Service -Riser Conductors & Ground Main Disconnect
32.
Equip. Clearances Panels-Motors-Mech. Equip.
33.
Clothes Closet Light -Shower Light -Spa Light
34.
Smoke Detector
72.
Kit. Fixt. & Appliance; Ground -Air Gap -Cooking Clearance
Date
73.
Card B-1 Date Card B-1
Date
74.
Card B-1 Date Card B-1
Date
75.
MECHANICAL (Permit) OK except #'s
35.
A.C. Ducts Insulation & Support
36.
Vent Fan, Exhaust above insulation
37.
Condensate Drain & Overflow, Size & Grade
38.
Furnace -Vent Access -Comb. Air -Return Air Vent 115 outlet
39.
Attic Access & Platform if Furnace in Attic
81.
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor l7 Yes
Date
82.
Card B-1 Date Card B-1
Date
83.
Card B-1 Date Card B-1
Date
84.
FRAMING (Permit) OK except #'s
40.
Sits Proper Materials & Anchors
41.
Walls Studs -Nailing Spacing & Braces -Plates -Sound
42.
Bearing Walls over Girders & Floor Nailing
43.
Draft Stop in Walls (rat proof)
44.
Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
45.
Headers & Beams -Size & Bearing
49.
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
50.
Bdrm. Windows or Exiting Doors -Sill Ht. & Dimensions
51.
52.
Garage Fire Protection Framing
Propei./ Line Firewall & Openings
53.
Ext. Doors -One 3' -Check Garage 3rd Story, 2 Exits
54.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
55.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
56.
Siding -Nailing Veneer
57.
Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
3.Glazing
Area -Glass Protection -Skylights -Plastic
59.
Shear Walls; Nailing -Bolts
60.
Brace Interior/Exterior Wall Panels
61.
Insulation -Walls -Ceilings
62.
Infiltration -Walls -Windows
U...
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
"ate
FINAL (Plans) OK except #'s
63.
Ext. Steps -Door & Sidelight Protection -Landings
64.
Smoke Detector
65.
Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor -Ducts -Meth. Protection
66.
Bedroom Exiting
67.
G.F.I. & Bath Fixtures & Tub Access -Spa
68.
Elec. Trim & Subpanel, Breaker Sizes & Labels
69.
Stairs & Rails
70.
Fireplace or Stove, Clearance -Hearth
71.
Elec. Outlets at Wood Panel, Int. & Ext.
72.
Kit. Fixt. & Appliance; Ground -Air Gap -Cooking Clearance
73.
Elec. Outlets & Receptacles at Kit. Counter
74.
Garage Fire Door; Swing -Landing -Closure
75.
A.C. Duct in Garage -Damper
76.
Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor -Meth. Protection
77.
Plb., Elec. & Mech. Equip. Listed for Location
78.
Elec. Receptacles in Garage (F.F.I.)-Romex Protection
79.
Insulation -Foam -Looked in Attic
80.
Guard Rails & Deck Construction -Post Caps
81.
Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor l7 Yes
82.
Following Instld./Drive :J Yes Q No/Walks 0 Yes :1 No/Planters Yes '] No
83.
Stucco Brown -Finish
84.
A.C. Unit Disconnect, Electrical -Plumbing
85.
Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
86.
Water Well, Disconnect, Electrical, Plumbing
87.
Exterior Elec. Trim, G.F.I. Receptacle -Underground
88.
Ventilation Throughout House
89.
Glass Protection
90.
Corrections from Previous Inspections
91.
Gas Test -Meters Tagged, Gas -Electric
92.
Water & Sewer Connected -C/O to Grade -HD Approval
93.
Energy Compliance Certificate -Other Certificates
94.
Address Posted
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:
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING PIVISION
7 County Center Drive • Oroville, Californi , 95965 • Telephone (530)53 - 541 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT yL
ASSESSOR PARCEL NUMBER
064-260-019
ZONING
R 1
B ILDING PERMIT
OWNER ASSANTE, AGNELLO & LORENE
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
1700 R
91,800
OWNERS MAILING ADDRESS 6218 JOPLIN CT., MAGALIA 95954
CONTRACTOR'S NAME
SIERRA MOBILE
TELEPHONE
877-8575
CONTRACTORS MAILING ADDRESS
8965 SKYWAY, PARADISE 95969
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
91.800
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 20.00
Permit Fee
$ 301.75
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDINGADDRESS 6218 JOPLIN CT., MAGALIA
Energy Plan Checking Fee
$
$
PERMIT FEE
$
LOT NO.
SUBDNISION'S NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
Each Trap
7.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other
SPECIFY
Solar or heat pump water heater
23.00
Water piping
1 15-0015.00
Each as water heater or vent
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: MH ON PERM FND, EX SITE
Gas piping sy2tem 1 - 5 outlets
15.00
Building sewer
15.00 1 9 -nn
Mobile Home ISI GI W
@20.00
PERMIT FEE
$ 50.00
ELECTRICAL PERMIT
Fling Fee 20.00
800VOR LESS
Main Service 2o.A 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. 17 O 3g�
License Class V Lic. NO. 1
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors license
Law for the following reason:
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
Main Service TO
46.00
CCU000A
NEW CONST. DWEWNG OCCUP.
WPo
OR ADDNS. ( a ACC. S.
SO
3.5QFT;
NEW MULT
CONST. 'OUTLET
= RESID.
97.50
POWER APPARATUS
a SINGLE ourLEr CIR.
FIXTURESEX. Occup. OUTLET OR FIXTURES
.00
SAL O I.50
Ex. Occup. ounErs R IESIES D.OEA
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMIT FEE
$
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.
er'l 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 niinsurance c r and policy number are:
Carrier
Policy Number (25 1 'Up -a 'A 7
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
❑ 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 I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
,,/j - ,,
X _ 'JtX� Date _� ( /1711 9
Signature of Applicant - ❑ Owner ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
MECHANICAL PERMIT
Fling Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEt $
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE
TO AL FEE $ 374.75
H
EES
FLOOD
COF
P
PD
HD
ISSU
This permit is hereby issued under
of the Butte County Code and/or
indicated above for which fees have
By
PERMIT EXPIRES ON0
the applicable provisions
Resolutions to do work
been paid.
Date
Receipt No. 280883 63.00 5f0
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -I SPECTOR GOLDENROD-APPLICANT�_91(Date)
7r� COUNTY OF BUTTE - DEPARTMENT OFt F,� ,OPMENT SERVICES - BU DING DIVISION
a:•
r 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHON 530) 538-7541
PERMIT APPLICATION DATA SHEET
OWNER: S 7�—&ri--- ASSESSOR PARCEL NUMBER:
Proposed Building Use: Building Inspector: Date:
At time of permit application, I was advised the following data moat b4sum iffed prior to permit processing and/or issuance:
,�FX S�� Date Received By
❑
1.XI items have been submitted-----------------------------------------------------------------------------
/ Plot plans, 3/4 sets, signed by the preparer of plans. ----------------------------------------------------
V O) Complete plans, 3/4 sets, signed by the preparer of plans. ---------------------------------------------
04. Engineered plans, 3/4 sets, with wet signature on plans. All engineering must be shown on plans.
❑ 5. Engineered truss details and layout in duplicate (required prior to plan review) No faxes! ---------
0 6. Energy Design Compliance and supporting documentation.
❑ 7. Statement of Intent for Non -Heated and A/C Buildings. ----
0 8. Hazardous Material Form. -------------------------------------
9. red anufactuHome data and installation instructions including Tie Down Specifications.
eesof $ -------------------------------------------------------------------
11.Impact fees as shown on the attached schedule. -----------------------------------------------
❑ 12. California Department of Forestry plan approval/fees. ---------------------------------------
1 . lood elevation certificate. ----------------------------------------------------------------------
Sanitation and plot plan approval Health Department. -------------------------
15. City of Chico plumbing permit------------------------------------------------------------------
❑ 16. Plot plan and business license approval from the City of Biggs. ---------------------------
❑ 17. Planning approval for (A) Use: (B) Parking: --------
k.
.Y
I�MIMIZZ
1118. Contact Land Development about O Improvements, ❑ Drainage, ❑ Legal Parcel. -----------------------
9. Encroachment Permit for driveway (construction approval prior to occupancy). ----------------------------
4re-inspection for re4uired. Request to Building Inspector on ate)
❑21. Contractor's license information. (Number, Name Style, Classification). ------------------------------ ------
❑22. Workers' Compensation carrier and policy number. --------------------
1123. Owner -Builder Verification (Given to owner ❑, Mailed to owner ❑).
024. Letter of signature authorization. ------------------------------------------
1325. Recorded copy of Agricultural Acknowledgment Statement. -----------
❑26. Letter of intent on building use. -----------------------------------------------------------------------------------
❑27. Manufactured Home utility clearance. -------- --
----------------------------------------------------------------
28. Existin®y�4laxions andor.,gxpired ts----------- -------------=---------------------------------------=---
1�
2 . ❑433 A, Grant Deed, M.H. itle Check to H.C.D -3,00, .--------------- /�/QU 9:ot
❑30. Other: ___ 1, 1
When you issue the t,�r��ss a� follows ❑Mail to owner, ❑Maij o contractor.
❑ Telephone �5 and hold for pickup at – office. ❑ Deliver with inspector.
Applicant: 4 - Date:
Copy of Haz-Mat form sent ❑ Health Department, ❑ Fire Department, ❑ Air Pollution
Copy of plans sent ❑ Health Department, ❑ Fire Department, ❑ 9ther;
Index permit application for the above items numbered:
2. Additional items required: - ' '
Date: By:
Date: By:.
/// 7 ' 7
❑ Plan Check List
Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date:
Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date:
Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by Date:
Contractor, designer, owner, was J�e��� data by c3 phone, ❑ mail, ❑ Building Division counter, by Date:
Plans reviewed by: �` ate: Plans approved by: Date:
Sets of plans on hold in ❑ Plan Cabinet, ❑ A.P. folder. Note transfer by: Date:
Yellow Copy - Department of Development Services, Building Division.
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541PERMIT N
�r% r%° aAt-we Aaa A M, 0wwr-w���E,��4_
(Fiev.1ZM6) hriru%oAIIliv,N AND PERM
i
A°°MORPAR&NUM°M D�
ZOMMO
BUILDING PERMIT
0 -"TI �iU �l 02 erg
T�pNC
SO. FT. OCC. BUILDING VALUATION
OwNIM MAL" A0�/...
CY
O
14 D
CONTRACTOR'S HAM
TCU'1110N!
OOMMCT0117 MALPQ ADOM80.
OONSTrAOCTM IOOER
u:NDOM MARM Aooaess
Fireplace
Total Valuation S
OO
APICP T OR ENGINM
UCEN°E NO.
Filing Fee��
S 20.0
Permit Fee
AACWrWr OR ENONE6 'S MAIM AD ON
Plan Checkin Fee
i , OQ
°�'LO°1°A°OREit 6� Q
v
Energy Plan Checking Fee
i
i
PERMIT FEE
_
lorwo
sueawsarraNAME
PAan ""�
PLUMBING PERMIT
Filing Fee 20.01
USEOFSTRUCTURE
SF ❑ Duplex O Mobllshome O Other
Each Trap
7.00
Solar or hent pump water heater
23.00
Water piping
15.00 ,D6
Each gas water heater or vent
15.00
TYPE OF WORK
New O Addition O Remodel O Utirltiea O inetslation O Other O
Describe Work: /%'I �� �� /��/!/I �iLJI� ` o,�L /L�fre
Gas piping system 1 - 5 outlets
15.00
Building sower
15.00
Mobile Home I S I G I W
(920.00
PERMIT FEE
S �,Qd
ELECTRICAL PERMIT
Filing Fee 20.0
Main Service owo.R=
23.00
/ -7
/u�(JJ) OIL)
✓/)
I
MainService soon To ,000w 48.00
OR CONST. v?."NO OCCUP. a0
OR ADa+s. a Acc. etna. 3.SCFT.
NEW CONST.VUCH CricET @7.50
POWER APPARATua
a s o aR
Ex. Occup. ounzr OR FOnUREB 20 0 1.00
a11L .w
Ex. Occup. 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE _
MECHANICAL PERMIT Fling Fee 20.0
Heating----_
Cooling
Hood 8.50
Ventilation
PERMIT FEt: S
Mobile Home Installation Fee $
Energy Inspection Fee S-
ocC COMT. TYPE TOTAL FEE $374,
NAZ. 0. FEES ,MP I FLOOD I COP I PAACEL I PO I M 1—
This permit is hereby Issued under the applicable provision
of the Butte County Code end/or Resolutions to do w.or
indicated above for which fees have been paid.
By
PERMIT EXPIRES ON
Date
PERMIT NO. . 3095 -BB
i
t'
PERMIT EXPIRESy
(OWNER Neal Asante
.CONTR. Holmes Mobile Home Serv., Oroville
,LOCATION (A.P. 64-26-19 )
30 Joplin Ct.,lot 163, PP#15, Magalia
• 1 '
Temp. Power Pole
Called PG&E
Temp. Elec. S fv..
Called P -&E _
Temp. Ga Serv. _
f
Call d PG&E _
J
F NALED�
(Date)
t
(Signatu
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
'BUILDING INSPECTIQNREtCORD `
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 Piping
Piers
Roofing
Sewer
Garage
Fdn. Vents
Fixtures
Footings
Stemwall
Garage Vents
Insulation
Water Htr.
Heaters
• Slab
Carport
Footings
Prov. for ph sically
handicaped
Conformance of ex.
structure
Appliances
Gas Piping &Test
Temp. as
Slab
Final
Sanitation
Patio
FIREPLACE
Final
Footings
Footinq
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
Brown
Cooling
Temp. Pole
Finish
Ducts
Underaround
Interior Lath Ventilation I Permanent
Door Closer Final Final
MOBILEHOME UTILITIES ------------------ Elec. Service Elec. Pedestal
Water Piping Sewer Gas Piping
MOBILEHOME INSTALLATION - - - - - - - - - - - - - - Support Elec. Continuity
Water Piping Drainage Gas Piping
DATE REMARKS OR CORRECTIONS
• Ods � ��
a
(NOTE: An entry must be made on this form each time you visit the job site.)
' f
'COUNTY OF BUTTE - DEPARTf� ENT OF PUBLIC WORKS?
7 County Center Drive - Oroville, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
autnorize representatives or the county or tsutte to enter upon the
above-mentioned property for inspection purposes.
X c�O Dates
ignature of Permitee or Agent
Receipt No. .1-3 9-T---3
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECTO F � BLIC WORKS
By ' Date .S^�
BLding permit expires D 1 ��7 y 0
BUILDING
Owner 1 - 114N•%
SQ. FT. OCC. BUILDING VALATION
D�
j
Mailing Address O C -r
H214015,5 CSL ,•
Telephone No.
8 -ay9'J
v
1`
Contractor /toL- 5 rlol kk 1,101-tc- _ eF,Qv,
Alk
Mailing Address 3j4(( K(Cyrez_ j.. uer
Fireplace
Total Valuation
illff/e �S
Telephone No.
y_�Sp/
Permit Fee
Building Address
Plan Checking Fee&/or Penalty
Permit Fee
ry C gl2At7i5� �rU��S
PLUMBING No. @ FEE
PERMIT FILING FEE $3.00
Each Trao 1.50
Repair drainage or vent piping 1.50
A. P. No. .�
Ap y-
Zoning & Planning
Water piping 1.50
Each gas water heater or vent 1.50
Fees
0ikyt4
Fire Dept.
Fire Zone
Use Permit
Gas piping system 1 -5 outlets 1.50
EQA
Parking
Plans
Parcel
Declaration
Parcel Map
60' R/W
Improvements
Each additional outlet .30
Building sewer 5.00
BI Ions Recd
Parcel Approval
Pla proval
Lawn sprinkler system 2.00
NEW 0 ADDITION ❑ UTILITIES ❑ OTHER ❑
Permit Fee $
ELECTRICAL No.1 @ FEE
PERMIT FILING FEE J$3.00
Main service 600V OR LESS
100 AMP OR LESS 5.00
Single Family ❑ Duplex ❑ Mobil Home Others ❑
Main service EA. ADD'L 100 AMP 2.50
'
Main service OVER 25.00
100 AMPP OR LESS O
Main service EA. ADD'L 100 AMP 1.00
NEW CONST. ( OWEL1114.
OR ADDNS. ACCLBLDGS,CCUP. 4) 22sq ft
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: ,
jHc O2CS �obi�C /,�O/YF S -,'J2. vC�9
NEW CONSTR_ MOLT I.OUTL T
NON.REsID BRANCH CIRCUITS)J 12.50ea
NEW CONSTR. POWER APPARATUS 6
NON.RESID. (SINGLE OUTLET CIR.
Ex. Occur (OUTLETS OR FIXTURES B L�;
FIXED ALINIS
Ex. Occup.(OUTLETSP(RESID.)REA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. SZZI 3-7% Classification
Misc. Wiring 6.25
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
MECHANICAL No. @ FEE
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
toI have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
ElI certify, that in the performance of the work for which this
permitis issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
Cal i forni a.
PERMIT FILING FEE 1$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
Land Development Fee s
$
TOTAL PERMIT FEE
$ 4 aC
autnorize representatives or the county or tsutte to enter upon the
above-mentioned property for inspection purposes.
X c�O Dates
ignature of Permitee or Agent
Receipt No. .1-3 9-T---3
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECTO F � BLIC WORKS
By ' Date .S^�
BLding permit expires D 1 ��7 y 0
fifi
i
V PERMIT NO. 4399-78P;E
PERMIT EXPIRES YINI#71
-OWNER Neal Assante
CONTR. owner
64-26-19
LOCATION (A.P. �
;i
30 Joplin Ct. , lot 163, PP#15, Magal is
S.'
2
Q .
S
t7}}.
I
Temp. Power Pole
Called PG&E
Temp. Elec. Serv. •j
Called PG&E o
Teml Gas Serv.
PG&E
/Called
JOB
FolALED
(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
number S ' S I for the following location:
3. -- t,w , C1- ;I. - G
Owner AI -
-Owner's Address
Mobilehome Mfg. Model Year
Insignia No. i7 = ��� Serial No.
It is hereby certified for occupancy at the above described location and
may be occupied.
Director of Public Works
Date i� �' 4 /l i By 64 -
THIS
THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED
White - Owner, Yellow - Installer, Pink - D.P.W.
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION RECORD
k BUILDING /T\ BUILDING (Cont'd) AN PLUMBING
b LoacK
F ewall
Jr Sd`4 Piping
Scratch
Forr►s
Par ets
111 Floor
Coo g
Maln Bldg.
Restr m Finish
2n loor
Underound
Faotin s
Window
3rd or
'Door Closer
StemwaII
Sidina
To out
Elec. Service
Slab �1
Roof Sheath"trig
Water Pi in
q s Piping
Piers
Roofing
Sewer
Water Piping l
Garage
Fdn. Vents
Fixtures
Footings
Stemwa I I
Garage Vents
Insulation
Water Htr.
Heaters
V
Slab
Carport
Footings
handicaddr pehysically'
Conformance of ex.
structure V
Appliances
Gas Piping & Test
Temp. Gas
Slab
Final
Sanitation
Patio �p
FI'll PL CE
Final
Footings N
Footing
ELEC RIC
Masonry Walls
Throat
Rough
Reinf. Steel
Final
Fixtures
Bond Bea
IRE SPRINKI EPA
I Motors
Mesh 4MECHANICAL
I
Grd. Fault Prot.
Scratch
Heatid
Service
Brown
Coo g
Temp. Pole
finish
is
Underound
4ND
In'terlor Lath
entilation
Pe anent
'Door Closer
inal
FinaJI
MOBILEHOME YTILITIES - - - - - - - - - - - - - - - --m -
Elec. Service
EI Pedestal —
Water Piping C �V -
Sewer `
q s Piping
MOSILEH2WE INT L ATI N - - - - - - - -
Support
eElec. Continuity
Water Piping l
Drainage
Gas Piping
DATE ,p REMARKS OR CORRECTIONS
J J-7 V 6,4
0x -
`C TJ
n1 /c rvf s,
(/ 9-1 b GSL
Ck
;AOTE: An entry must be made on this form each time you visit the job site.)
MOBILEHOME INSTALLATION INSPECTION CHECK LIST
1. Is the mobilehome located ith required separation from lot lines and buildings and generally
conform to plot plan? Ye No
2. Does the mobilehome have required clearances above ground? (Sec.5085) Yes\ No
r
3. Are footings and supports properly sized, spaced, and braced "-.per approved plans? (Note
possible variation at spring shackles.) (Sec. 5082. & 5083) Yes No
4. Is the mobilehome level? (Sec. 5088) Yes _/ TNo_
5. If more than a single unit, are crossover connections properly installed? {Sec. 5088)
Yes—+—No_
6. Water
A.. Is flexible connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566)
YesNo_
B. Test - Does water piping withstand working pressure or 50 lbs. air test?Xs No
C. Backflow - If coa i not State of California approved, does station have backflow device
and pressure -relief ve? Yes_ No
7. Wastes and Drains
A. Is connection made with Schedule 40 DWV and have flex connectors at each end? YX.— No
B. Does it have minimum" per foot slope and is it properly supported? Yes`*! ' No
C. Are any leaks detected in drainage system after -running 3 -gallons of water through each
fixture including washing machine standpipe?,Yes • NOL*;
D. If coach is �t State of California approved; does station have required trap and vent?*
Yes No
8. Gas Piping and Gas V nts
A. Connector - Is mo ilehome connected to he gas supply with an approved 3/4" minimum
mobilehome connect r not more than 6 long? Note: All piping is to be at least as
large as the mobile ome gas line inle without reductions other than the mobileh"ome
connector. Yes N
B. Test OK as per followin procedure Yes No
1. Open all appliance c nnector aloes.
2. Shut off appliance bur r d pilot valves.
3. Air test with manometer 10"-14" water column; or test with slope gauge (minimum '
6oz.-maximum 8 oz.) cal r ed in tenth pound increments. Test for 10 min. without
drop.
4. Connect gas meter to
soapy water.
C.. Are all appliance vents
bilehome with connector, turn on gas, test connections with
perly install d? Yes No
i
i
9. Electrical .
i A. Is service large enough to provide adequatd amperage -to mobilehome (must equal rating of
' mobilehome with a minimum of 700. amp). and other facilities orL-lot,? i.e., water pumps,
garage, cabana, etc.? Ye / No
B. Is there proper clearances around panels? Yes No
C. Is power supply.cord or feeder assembly properly fused?' YesN, No
D. Is continuity test satisfactory as per the following procedure? Yes,No
1. De -energize electrical wiring system of the mobilehome at the pedestal.
2. Make sure that the power supply cord or feeder assembly conductors, including neutral
conductor, have been disconnected.
3. -Switch all breakers and switches in the mobilehome to the "on" position.
' 4. Connect one lead of a test instrument to the mobilehome grounding conductor and
apply the other lead to each mobilehome supply conductor, including neutral.
5. All non-current, carrying metal parts of the mobilehome (aluminum siding, gas line,
water line), including fixtures and appliances, shall be tested for continuity from
such equipment and the grounding conductor.
6. Upon completion of the above procedure, the power supply cord or feeder assembly
conductors shall be connected to the site service equipment. A further continuity
test shall then be made between the grounding electrode and the chassis of the
mobilehome. Upon satisfactory completion of theelectrical tests, the lot or site
iservice 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.
I
MOBILEHOME DATA
Manufacturer and/or Namestyle
Length s` _ Width:5
i
Vehicle serial No. (%q ILZ IZZTr 4
State Identification No.
Additional Information or Comments:
COUNTY OF.Bl[4.TTE — 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.
,kx /A g� Date
gnoture of Permitee or Age Q _
Receipt No. -7 9 7J' 934SDJ
#White-D.P.W. — Y,A50sor • Pink-Ir5Qc®r(�ij Goldenrod -Applicant
This permit is hereby issued under the applicable proviSvq��r oi��
the Butte County Code and/or resolutions to do work ink iled'
above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
Boding permit expires Date F—/ ((_ 7
BUILDING
Owner lKe/ �
SQ. FT. OCC. BUILDING VALUATION
Mai I i ng Address (y(,
�^� ��
E)
T ep one Nb, `
`/
p
Contractor
Mailing Address
Fireplace
Total Valuation
Telephone No.
Permit Fee
Building Address V
Plan Checking Fee&/or Penalty
Permit
Pit Fee
• /(91s�_
PLUMBING No. @ FEE
PERMIT FILING FEE $3.00 .-
Each Trao 1.50
PQHirig[ication Only
Repair drainage or vent piping 1.50
q— A � � � t+,
A. P. No.` 'T o
/Z j'-
irtg
Water piping �}
Each gas water heater or vent 1.50
F qe,
Sa n
Fire Dept.
Fire Zone
Use Permit
Gas piping system 1 - 5 outlets 1.50
EQA
Parking
Plans
Pa elEach
De ration
Parcel p
60' R/W
Improvem is
additional outlet .30
Building sewer �}
BI J. Q Recd
ParcLlAopooprovol
Plans Approval
Lawn sprinkler system 2.00
NEW ❑ ADDITION ❑ UTILITIES OTHER ❑
Permit Fee $ DO r
�,
ELECTRICAL No.1 @ FEE
PERMIT FILING FEE $3.00
Main service 60000 AMOR P LESSOR SS 5.00
Single Family ❑ Duplex ❑ Mobil Home Others ❑
Main service EA. ADD'L 100 AMP 2.50
500 SQ. FT. MINIMUM
AOR MOB!' ES
OVER 600V 25.00
Main service 100 AMP OR LESS
Main service EA. ADD'L 100 AMP 1.00
NEW CONST. DWELLING OCCUP. 4
OR ADDNS. % ACC. BLDGS. 2¢Sgft
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:
T
NEW RESID,CONSTRANCH CIRCUITS)
NON.RESID (BRANCH CIRCUITS 2.50ea
NEW CONSTR. (POWER APPARATUS B
NON-RESID. (SINGLE OUTLET CIR.
EX. OCCUD(OUTLETS OR FIXTIIRES BAL 21
FIXED APPLS. OR
Ex. Occup.(NOUTLETS (RESID.) EA) 2.00
'Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
xI am exempt from the Contractors License Laws of the State of California.
Permit Fee $r975 3&$
W57-1
MECHANICAL No. @ FEE
WORKMEN'S COMPENSATION INSURANCE
I am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
I certify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
Land Development Fee
$
TOTAL PERMIT FE
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
,kx /A g� Date
gnoture of Permitee or Age Q _
Receipt No. -7 9 7J' 934SDJ
#White-D.P.W. — Y,A50sor • Pink-Ir5Qc®r(�ij Goldenrod -Applicant
This permit is hereby issued under the applicable proviSvq��r oi��
the Butte County Code and/or resolutions to do work ink iled'
above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
Boding permit expires Date F—/ ((_ 7
4
• �COUN'TY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive, — Oroville, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X/9-m--pZew 6a�z� Date
SignatVir f Permitee or Agent
Receipt No.V ,fla 0
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.
DIRErtMR OF PUBLIC WORKS
B Date/0//�
Building permit expires Date lell / 7
BUILDING
Owner 9=
SQ. FT. OCC. BUILDING VALUATION
Mailing Agress
Telephone No.
Contracto
Mailing Address 63Z
Fireplace
Total Valuation
1
T ephone N
7 C
Permit Fee
Building Address
Plan Checking Fee Vor Penalty
Permit Fee
C? a
PLUMBING No. @ FEE
PERMIT FILING FEE $3.00
Each Trap 1.50
Repair drainage or vent piping 1.50
A. P. No. n ,
Zoning & Planning
Water piping 1.50
Each gas water heater or vent 1.50
F04/sl
Saeri•4at
Fire Dept.
Fire Zone
Use Permit
Gas piping system 1 -5 outlets 1.50
EQA
Parking
Pyans
ParcelEach
I Declaration
I Parcel Map
60' R/W
Improvements
additional outlet .30
Building sewer 5.00
Bldg. Pans Recd
Parcel royal
PI Approvol
Lawn sprinkler system 2.00
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER
permit Fee $
is
'
ELECTRICAL No. @ FEE
�>
d'
PERMIT FILING FEE $3.00
00V OR L
Main service 100 AMP ORSLESS 5.00
Single Family ❑ Duplex ❑ Mobil Home 43/ Others ❑
Main service EA. ADD•L 100 AMP 2.50
Main service OVER 600V 25.00
100 AMP OR LESS
Main service/ EA. ADD•L 100 AMP 1.00
NEW CONSTOR ADDNS. \ ACCDWELBLDGS.LING CCUP. 7i) 22sgft
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
le of:
NEW CONSTR ( ULTI-OUTL T
NON.RESID `BRANCH CIRCUITS) 12.50ea
NEW CONSTR. (POWER APPARATUS e
NON-RESID. SINGLE OUTLET CIR.
Ex. Occup{OUTLETS OR FIXTIIRES B L0;
Ex. Occu / FIXED APPLNS. OR
p•\OUTLETS (RESID.) EA) 2.00
Temporary service 110.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
MECHANICAL No. @ FEE
WORKMEN'S COMPENSATION INSURANCE
I am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
Qhave placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
t 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 1 2.00
Pe - r
$-U ,.
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
Land Development Fee
$
TOTAL PERMIT FEE
$ 30
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X/9-m--pZew 6a�z� Date
SignatVir f Permitee or Agent
Receipt No.V ,fla 0
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.
DIRErtMR OF PUBLIC WORKS
B Date/0//�
Building permit expires Date lell / 7
1. Owner's name:
BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS
7 County Center Drive, Oroville, CA.
PHONE:'534-4541
I
MOBILEHOME INSTALLATION SHEET
2. Installer's name:
3. Is the site currently under permit? Yes No
(If yes, furnish permit number ) OR
Is the site an existing site? Yes / / No /-
(If yes, furnish two (2) plot plans.)
I
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 /4 No
(If no, clarify
)
5.
What
is the mobilehome
electrical rating? -----------------------
/S`—�
Amps
6.
What
is the mobilehome
site service rating?
C;L0 O
Amps
7.
What
is the mobilehome
site circuit breaker
rating? -------------
Amps
8.
Is there any other electric load to be served by the mobilehome
site
service? ---------------------------------------------------
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
11.
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.)
MOBILEHOME SUPPORT DATA
If other than single wid
Mobilehome Mfr /O furnish Setup Model No.Ctto JC — 3. Year 1S
Width_Y41 (ft.) Box Length .0 o (ft.) Tagalong'or Expando Size ft. x ft.
(SHOW SUPPORT DETAILS BELOW)
On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation
manual and structural setup sheets'(if not on file with the County of Butte).
All center supports measured from front of
mobilehome unless otherwise specified.
Footings (check one)
(ft.)(in.)
Center support
locations;
(ft.)(in.)
I o
(ft.) (in.)
(ft.) (in.)
Single
A A
%dx3o
(in.) (in.)
Center support
footing sizes
(in.)
(in.) (in.). i , I
3v
(in.) (in.)
1. Wood either
pressure treated or
foundation grade.
2. Other (specify)
Supports (check one)
R1. Concrete block.
0 2. Other (specify)
4 --Tagalong or Expando,
show support details.
%Ax !jU -- Typical Support
(in.) (in.) Footing Size
x v
(in.) (in.) �'- -- Max. Pier Spacing
Max. Overhang
(in.) (in.)
(ft.) (in.)
BUTTE COUNTY
Ila,
x 3v % BUILDING DEPARTMENT
I
APPROVED �
*If center piers are other than drawn above,
draw in locations, spacing, and dimensions.
NOTES
RESIDENTIAL
PERMIT NO.
064-260-019 05-2367
DRENNAN, GENE & ALBERTA
6218 JOPLIN CT, MAGALIA
Cont: OWNER
t ELEC SERV
SPECIAL CONDITIONS
CHECKED
BY
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
Z(� C—Z OAF cis Tom -
N6W?- PONOEROSA
OFFICE COPY
I
r
Address
GAS ,
Meter By Date
ELECTRIC
Meter By W % Date T&
I Ib _C$r -os
JOB FINALED (Date)
Signature�L'
w
d"OK
o. WOK
. = NalAppfimNReady ele
Not
MOBILE HOMES
Date
MOBILE HOME UTILITIES (Plans) OK except #'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;.4 /"L'ft
/ P Nat or/ /" L 'ftJ P LPG
7. Well Clearance & Disconnect
8. Utility Clearance -
Date Card B-1 Date Card B-1
Date Card B-1 --Date, Card B-1
Date MOBILE HOME INSTALLATION (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
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-Connedoe
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
Date Card B-1 • Date Card B-1
Date .-Card B-1 Date Card B-1
Date PERMANENT END SYSTEM (ONLY)
1. Zoning Requirements-Setbacks-Easemerds
2. Footings; Sae -Spacing -Marriage Line
3. Blocking -
4. Gas; MH Test -Demand -Valve
S •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 Cana B-1 Date Card B-1
Date Card B-1 Date __ Card B-1 _
MISCELLANEOUS
Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Footings; Soils -Sae -Depth -Spacing -Connectors -Steel
3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails
4. Wood Awn.; Posts-Beams-Rftm-Connectors
Shthg-Frg-Bracing
S. Alum. Awn.; Columns-Connections-Splice-Decal-Enciosures
6. Carports•, Windows -Doors
7. Electric -
8. Frmg.; Sills-Anchors-Studs-Rftrs-Tnuses
9. Siding; Nailing -Veneer -Stucco -Mesh
10. Roof; Stnthg-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 -Stricture Stability
3. Pool Structure; Steet-Connections-Thickness
Dead Men -Lining
4. Elec.; Receptacles and Lighting, Distance-GFI
5. Elec.; Pool Lighting; l5 Volts -GF] .
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Elea; Bonding; Metal w/5' -Circulating Equip. -Heater
8.'E]&-; 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 '
l 1. _tight Niche
_12. ,Enclosure; Fencing -Alarms.
Date _Card B-1 _ _ Date Card B-1
Date Card B-1 Date Cana B-1
= ac
Not OK
= NA ApplimWe
ret Ready
RESIDENTIAL (Single & Duplex)
]ate 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./ /" Rg. Depth
4. Ftg., Porches & Decks; Soils -Steel-/ I" Ftg. Depth
S. 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. DAV.; Fall-Fffing-Test-2 Way C/O -Sewer Test
10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test
11. Water Pipe; Test-Anchors-RegulatorService Test
12. Electric Underground
13. Plenums & Ducts; Clearance -Material -Support -Ins.
14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
15. Access & Ventilation
16. Insulation
Data 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
22. Gas Pipe; Sixe & Anchors
23. Fire Sprinkler; Test
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1 •
Date
ELEC AL (Permit) .OK except #'s
Fbdure & Transformer Clearance -Ins. Protection
25. filet. Receptacles Spacing -Lights & Switches at Doors
26. Size Boxes & No. of Conductors Stapled
27. RoMex Installed Close to Edge of Studs & C.J.
quip. Ground made up w/Meth Fasteners -Bond Gas & Water
29. 2 Appliance Circuits in Kitchen & Conductor Size GFI
30. Subfeed Wire Size/ /ga. Cu or AI-A.C. Wire Size/ /ga Cu or Al
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 -Meth. Equip.
34. Clothes.Closet Light -Shower Light -Spa light
35. Smoke Detector
Cate ltJ - Iy •OS Card B-1 t_\_S)4O S Date Card B-1
Cate 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. Fumace-Vent Access -Comb. Ait-Retum 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 A Flue -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-Underfk Access
59. Glazing Area -Glass Protection -Skylights -Plastic
60. Shear Walls; Naffing -Batts
61. Brace Interior/Exterior Wall Panels
62. Insulation -Walls -Ceilings
63. Infiltration -Waft -Windows
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date FINAL (Plans) OK except Its
64. Ext Steps -Door & Sidelight Protection -Landings
65. Smoke Detector
66. Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor -Ducts -Meeh. Protection
67. Bedroom Exiting
68. G.F.I. & Bath Fixtures & Tub Access -Spa
69. Elec. Trim & Subpanel, Breaker Sizes & Labels
70. Stairs & Rads
71. Fireplace or Stove, Clearance -Hearth
72. Elec. Outlets at Wood Panel, Int & Ext
73. Kit. Full. & Appliance; Ground -Air -Gap -Cooking Clearance
74. Elec. Outlets & Receptacles at fit Counter
75. Garage Fre 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 (F.El.)-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 0 Yes 0 Na/Walks O Yes 0 No/Planters O Yes 0 No
84. Stucco Brown -Finish
85. FIC. Unit Disconnect, Electrical -Plumbing
86. Vents Above Roof, Plbg-Appriance-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:
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
PERMIT NO.
BP052367
LICENSED CONTRACTORS DECLARATION
Issued Date: 09/02/2005 APN: 064-260-019-000
1 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
Site Address: 6218 JOPLIN CT MAG
effect.
License Class : License Number:
Map Index:
Date: Contractor:
Description: ELECTRICAL SERVICE RELOCATION
OWNER -BUILDER 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
Owner: DRENNAN, GENE L & ALBERTA V
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
PO BOX 631
signed statement that he or she is licensed pursuant to the provisions of
MAGALIA, CA
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
95954
she is exempt therefrom and the basis for the alleged exemption. Any
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
Applicant: DRENNAN, GENE L & ALBERTA V
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and who does
such work himself or herself or through his or her own employees,
PO BOX 631
provided that such improvements are not intended or offered for
MAGALIA, CA
sale. If however, the building or improvements are sold within one
95954
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
❑ I, 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,
Contractor:
and who contracts for such projects with a contractor(s) licensed
pursuant to the Contractors' State Lice Law.).
❑ I am Exempt under Article 3 of the si ss and Professions Code
q—Z_oS
Date: Own
WORKERS' COMPE SATION DECLARATION
I hereby affirm under penalty offierjury one of the following declarations:
License #:
❑ 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.
Architect:
❑ I have and will maintain workers' compensation insurance, as
Engineer:
required by Section 3700 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier:
Total Square Ft: 0 S.F.
Policy #:
Valuation: $0.00
❑ I certify that in the performance of the work for which this permit is
Census Code:
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'
(�
(_
compensation provisions of Section 3700 of the Labor Code, I shall
C�1
forthwith comply with those provisions.
Date:
Applicant:
9 - 2-
WARNING: Failure to secure workers' compensation coverage is
v
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 is hereby issued under the applicable provisions of the Butte County Code and/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.)
Resolutions to do work indicated above. for which fees have been paid.
Q-2- O 5
Name:
ate:
By: /D`
2-0
PERMIT EXPIRES ON: l - l�
Address:
Date
❑ 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 dull auth rized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any o ial to or document of Butte County. I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.
Print Name: C7 L �J /�- G ��A� Signature:
9— 2 —
Date:
Owner 0 Contractor ❑ Agent for Owner 0 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 INFORMATION
Last Name/ l� L� ti First Name
Address
O� D
City 411 �e i
Stale
Zip9�4fy
Phone.p,�_7 _337
Fax,
E-mail
A,PPLIPANTSiGNATURE
X
For offp6 use only:
CONTRACTOR
Name
4,5
Address
SRA
City
I No
State
Zip
Phone
Map Book
Fax
E mail
Planner
Lic. #
Class
A,PPLIPANTSiGNATURE
X
For offp6 use only:
ARCHITECT/ENGINEER
Name
4,5
Address
SRA
City
I No
State
Zip
Phone
Map Book
Fax
E-mail
Planner
State License Number
A,PPLIPANTSiGNATURE
X
For offp6 use only:
APPLICANT INFORMATION
Name
4,5
Address
SRA
City
I No
State
Zip
Phone
Map Book
Fax
E-mail
Planner
A,PPLIPANTSiGNATURE
X
For offp6 use only:
Zoning
Property Address
d�z/ C?
Flood Zone
Cross Street
c147,
SRA
I Yes
I No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
OVER FOR SUBMITTAL REQUIREMENTS
PERMIT
NO.
BPO 523
BIN #
PROJECT LOCATION
AP# ro r^ - 0
lU —1
Property Address
d�z/ C?
City
Cross Street
c147,
WORKER'S COMPENSATION
Policy Number
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
Description or Scope of Work:
e l cA� i n YtpVice
Sq FT- Living Garage Open Cov
❑ 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.
I I Received by: K Amount: SIS, 00 Bldg I I
Receipt M 1351{72
I I Date: q- 2-
Il 0 \ner
� S5 • (30 TI
KAFORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 REV 8-12-05
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 AIC for Non -Residential Buildings.
C 6. Manufactured homes: (A) Installation manual, (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. Building Permit Application Without Required Clearances Form
❑ 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).
0
2.
Impact Fees.
FI
3.
California Department of Forestry plan approval (if required).
❑
4.
NPDES Form.
I❑
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.
❑ Legal description from current recorded grant deed, ❑ Copy of M.H. Title, Title transfer, or MCO.
❑
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
KAFORMSMILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 8-12-05
T . F,
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.
BP040886
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: 04/01/2004 APN: 064-260-019-000
the Business and Professions Code, and my license is in full force and
effect.
License Class : License Number:
Site Address: 6218 JOPLIN CT MAG
Date: Contractor.
Map Index:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Description: MOVE ELECTRICAL SERVICE
Contractors' State 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
Owner: DRENNAN GENE L & ALBERTA V
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 Contractor's State License Law (Chapter 9 commencing with Section
P O BOX 631
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: DRENNAN GENE L & ALBERTA V
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
P O BOX 631
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
sale.).
95954
❑ I, 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 contractor(s) licensed
pursuant to the Contractors' State Lice Law.).
Contractor:
❑ lam Exempt under Article 3 of the B iness Ind Professions Code
4 Date: / Owner:
WORKERS' COMPENS ION DECLARATION
I hereby affirm under penalty of pe ' ry 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
License #:
Labor Code, for the performance of the work for which this permit
is issued.
❑ I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
Architect:
the work for which this permit is issued. My workers' compensation
Engineer:
9
insurance carrier and policy number are:
Carrier.
Total Square Ft: 0 S. F.
Policy #:
I certify that in the performance of the work for which this permit is
Valuation: $0.00
issued, I shall not employ any person in any manner so as to
become subject to the workers' compensation laws of California
Census Code:
and agree that if I sho become subject to the workers'
compensation provisions Section 3700 of the Labor Code, I shall
forthwith comply with th a provisions.
Date:
Applicant:
WARNING: Fail a to secure workers' compensation coverage is
unlawful, ands I 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 is hereby issued under the applicable provisions of the Butte County Code and/or
I hereby affirm that there is a construction lending agency for the
Resolutionto do work indicated above for which fees have been paid.
performance of the work for which this permit is issued (Sec 3097 Civ.)
. / D¢
Name:
BY c— Date:
PER EXPIRES ON:
Address:
ate
❑ 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 du aut orized agent of the owner. I agree to comply with
all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any o cial fo or document of Butte County. I hereby
authorize representatives of Butte County toenter upon the above mentioned property for inspection purposes.
Print Name: L /V�.^� 1//�G /V/J/�/(/ Signatu .
Date:
Uewner ❑ Contractor ❑ Agent for Owner 13 Agent for Contractor
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
PERMIT NO.
BP�oBg�
DATE.//nrrv: --.-..._.
- D ar,4-- 36a• oc4
OWNER'S LAST NAME: OWNER'S FIRST NAME: PHONE
,LD I ( tiL Y7-3- 3(397j��
STREET ADEc�`�(/ C� F
carr. zI(� E-MAIL:
SITE ADDRESS: G
NEAREST/TRO S STcRE^ET-y-� /1 7
TRACT/LOT A:
APPLICANT NAME: /-� � ���� j
PHONE
C� �f�L /vc= �N
STREET ADDRESS: �^ �M Q
iT l_
FAX
CRY. ZIP:
E-MAIL:
CONTRACTOR NAME:
PHONE
STREET ADDRESS:
FAX:
CITY, ZIP:
E-MAIL-
LICENSE NUMBER:
LICENSE TYPE:
ARCHITECT/ENGINEER NAME:
PHONE
STREET ADDRESS:
FAX:
CITY, ZIP:
LICENSE NUMBER:
E -NAIL -
1 nE3 onnl C f1C AAMOV.
1
❑ Structure Built without permit
❑ 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 fees will be required.
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.
For office use only:
Notes:
Application Received by:1614 Date: 4/1/o4
Receipt number: 39545-GAmount Received: 55
D.B.-1
OWNER -BUILDER VERI7FICA.TION
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.
I personally plan to provide the major labor and materials for construction of the proposed
properly improvement : YES M' NO ❑
02. I HAVE.0 HAVE NOT 02(signed an application for a building permit for the proposed work.
cted with the following person (firm) to provide the proposed construction:
NAME:
ADDRESS: may:
PHONE: CONTRACTOR'S LICENSE NO.
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.
. 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:
PROPERTYOWNER:
DATE:__
NOTE: This Owner -Builder Verifwation 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. - .- - -
OVER
I OWNER BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of property
improvements specified.
For your protection, you should be aware that as "owner -budder" you are the responsible party of record on such
a permit 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 yowsel4 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 you plan to subcontract, you should
be aware of the following information for your benefit and protection:
0 If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $300 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
0 If you are an employer, you must register with the State and Federal Governments 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.♦ There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious
with respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contract 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 contracting the Contractors State License Board in your
community or at 1020 N Street, Sacramento, CA. 95814.
Please complete the "Owner guilder Verification" on the reverse side of this form so that we can confirm that you
are aware of these matters. The building permit will not be issued until the verification is returned.
rely.
h4ic 1 C. Vi ira, C.B.O.
er, Building Inspection
NOTE. YhIs Owner-Buflderinfomwtion is required by Section 19830 of the Calffornfa Health and Safety Code
OVER
064-260-019 00-0378 `
DRENNAN, GENE
6218 JOPLIN CR, MAGALIA
CONTR: SUBURBAN PROPANE
GAS LINE FOR HVAC
• t
OFFICE COPY
Address
G AS
Meter
E L E Date
t Meter B
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT O.
(Rev.12/96)APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER
a oW
ZONING
BUILDING PERMIT
OWNEJ
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
CWNEAS MAILING ADDRESS
'
CONTRACTOR'S NAME
TELEPHONE
CONTRACTORS A,WUNG DRESS
J.
"1 ,/f.-
CONSTRUCTION LENDER
Fireplace
_ENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $ 20.00
Permit Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
Energy Plan Checking Fee $
$
J% a
PERMIT FEE $
LOT
S D b NAME
PA EL MAP
PLUMBING PERMIT Fling Fee 20.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome 0 Other
SPECIFY
Each Trap 7.00
Solar or heat pump 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: � , � (. t,. .' � � �;� , �. 1`-+�• r' ('// 1 !-! f. I i 1 %�
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.00
Mobile Home S G) W @20.00
PERMIT FEE $ Wt's • j
/
ELECTRICAL PERMIT Fling Fee 20.,00
800V 0" LESS
Main Service 20.AORLESS 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 Bu ipess and Professions Code,
and my license in full force and effect. ,)
/ �� •-y
License Class A Lic. No. {/./
'OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors license
Law for the following reason:
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Prof ssions Code for this
reason Prof • _ r' _
Main Service To 46.00 J
CCU000A
NEW CONST. DWELLHJG GCS. 3.5QSO.
DWE200ALLING
OR ADONS. ( a ACC. eLos. FT.
N CO MULTI.OUTLET
pp,;.R.,p, ' @7.50 J
POWER APPARATUS
6 SINGLE OUTLET CIR.
� ® ,
Ex. Occu oUnETORFD=RES eAL so
XEDLNS
Ex. Occup. pH APP
R°E 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wirino 23.00
PERMIT FEE $
WORKERS' COMPENSATION DECLARATION ,
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
ti�-'f 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' compenslaation insurance caFrierano policy number are:
Carrier / % ' l , ' f �✓ l �tZ h t '
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEE $
_
Policy Num er 1"i
(The above section nee riot 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 I (r/% ! i , , r � //' /f r i/�� Date t/T /�(�
Signature of Applicant - ❑ Owner Contractor ❑ Agents
An OSHA permit is required for excavations over 5'0" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE
TOTAL FEE $ -
HAZ.
p-
D
coF
I PARCEL
pp
HD IS
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.
r . ' v, i r. y
By `f. Date
PERMIT EXPIRES ON
Da f®
Receipt No. % J
I
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
State of California
Business, Transportation and Housing Agency"�,a
.. !V
Department of Housing and Communftyt]avelopmant ,
Division a Codas nd Standards r�
APPLICATION FOR: ;:4.
'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 for Special Purpose Commercial Coaches or
Recreational Vehicles
1. LICENSED CONTRACTORS DECLARATION
's I hereby affirm under penalty of perjur 'ihai I am licensed under
provisions of Chapter 9 (commencing with Section 70001 of Division 3
of the Business and Professions Code, and my license is in full force and
effect.
License ClasA �A iE' * 74 Exp. Dat �//o7v
Contractor—.17N"bG 7 s /) Date
2. OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I 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 Code) or that he or
she is exempt therefrom and She basis for the,.alleged exemption: Anv_.
violation of Section 7031.5 by P
SECTION 1 - UNIT INFORMATION
I/We are requesting services for the following unit(0: '.
(Check Appropriate Box) ,
f
anufactured Home/Multi-Unit Manufactured Housing
anufactured Home/Multi-Unit Mfg. Hsg. Component Structure
creational Vehicle
mmercial Coach (Occupancy Group
ecial Purpose Commercial Coach
Decal or License No. `_!1 ✓
Serial Number(s)- 1-157&-7
Manufacturer Name/ (C -
Model Name / W
COL NO._::
FEE RECD
DATE C�2 31,* 7 G 0
AA NO.
RT TO vv
RT BY
Year of Manufacturer NIP' ` +.
STATE OF CALIFORNIA
%
Insignia/HUD Label Numbers) /
L Z
Department of Housing & Community Development
O'D
ITEMS ISSUED: HCD 59 (3 Gas ❑Electric ❑ 1. A. C.
ECTION 4 - DESCRIPTION OF WORK/ACTIVITY AND VALUATION • :r
Division of Codes and Standards
+r
SECTION- OWNER/APPLICANT INFORMATION
.pis form. Chec( box Qit plans accompany this applic)tion. Provide the make and model of any appliancce
FINAL INSPECTION CERTIFICATION
°
Owner ��/e /L / /F i
-7
Telephone No.
(J
_ _0
{ � J
yi�3j Ync/oQ4IG�Address04
BY: (:D No.)
Re_
City �Gr' County
F) SX
zip
--------
LABOR DATA: ARF -11 North ❑ South County No:
D
Location of Un' rf Different
Than Above
/� TR MILES
CODE { 0 1ALE_
SECTION 5 - SIGNATURE AND CERTIFICATION
/
Applicant Ci lZ U^f7lt�l Ya"T�l7��C.
PCAIACT
TIME: INSPL4CT �_ TRAVEL TIME _
I/We hereby make application for the services designated above. If applying for replacement of a lost
'I /
Address ' tom f'�O/ rl CL' ' t 9✓Cr/
insignia for the unit described in SECTION 1 above, I/we certify that there have been no alterations,
❑ MH PARK
additions, or modifications to the unit that would affect the unit's cottipliance with California or federal law
City / ,/ i 1 ird^ Zip - t��%
Telephone No.�'�/J 7 a '
INSPECTION DATA: Privato Property
corm inspection must be obtained.)_ E
..! `fit F c •'i-�o
• .. .. .-... _�.1�1 •: nY._.- .:t:
Lender's Addrdss-''gee
# HOMENNIT .' FLOORS
• Fbf..umtr` t is being requested).
SECTION 3 ONTRACTORCHITECT OR ENGINE INFORMATION
TOTAL CORRECTICNS: ��
.ontractor's Name
!: J}�-
VIOLATION DATA:
l: bjZ[Ii rNgTlj(�fs raverse side) ❑ Disapproved (see reverse side)
516 An, 4ie_lW �L
(1-1/1211 old
E nn P G/O _
NP_
lddress
W
s — F_ _
i
�—
trchitect/Engineer Name License No.
FEE COLLECTION AND OTHER INFORMATION:
FEES: $ CK#� DATE
ddress
...
ITEMS ISSUED: HCD 59 (3 Gas ❑Electric ❑ 1. A. C.
ECTION 4 - DESCRIPTION OF WORK/ACTIVITY AND VALUATION • :r
ATTACHMENTS: ❑ liedown Cert. ❑ Other
;scribe the proposed work/activity in detail. Att(tch additional pages if necessary. If structw r z!•gratir
remanufacturing are proposed, complete plans, specifications, details, and calculations must accon,N�
FILE CLOSED
.pis form. Chec( box Qit plans accompany this applic)tion. Provide the make and model of any appliancce
PERMIT NO: l l
to be installed and piovide complete electrical calculations fora y electrical'alte iationf or additions.
/ 7 - '
1'I I certify that in the performance of the work for which this permit is
L///lYJ/ G AY//JG
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 workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
(-`
r'
Applicant Date
WARNING: PENSATf6�
COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO
•'
15,2
Indicate the Total Cost of the Work to be Performed S 15, /, qb
CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS (9100,000), IN ADDITION TO THE COST OF
SECTION 5 - SIGNATURE AND CERTIFICATION
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF
THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I/We hereby make application for the services designated above. If applying for replacement of a lost
-'4. CONSTRUCTION LENDING AGENCY
insignia for the unit described in SECTION 1 above, I/we certify that there have been no alterations,
I hereby affirm under penalty of perjury that there is a construction
additions, or modifications to the unit that would affect the unit's cottipliance with California or federal law
" lending agency for the performance of the work for which this permit is
or the rules and regulations of the Department. (If alterations, additions, or modifications have been made, a
issued (Sec.3097,•Civ. C;1, -• _ Sd- �2:7lTt u
• 'Lender's Name 0.,.
corm inspection must be obtained.)_ E
..! `fit F c •'i-�o
• .. .. .-... _�.1�1 •: nY._.- .:t:
Lender's Addrdss-''gee
_.�(' 1r ✓.-r _ d J ,fry ' :s
to -
. 'gn, Bement insignia
5. CERTIFICATION ��"
• Fbf..umtr` t is being requested).
I certify that I have read this application and state�hl9�vn0
6a i• -'y$ . t r E TMENT USE ONLY
information is correct, I agree to comply with all City, an county-%+=.•.
!: J}�-
buildinonstruction, and
ordinances and state laws relating fo g c
l: bjZ[Ii rNgTlj(�fs raverse side) ❑ Disapproved (see reverse side)
e
hereby authorize representatives of this county to•nter upon the
_
above-mentionnred property for inspection purposes.
it v r0/
Signature of Department Re ve Date
Signature oiApplicgnt or Agent Date
DEPARTMENT WHITE -
PINK - OWNER/APPLICANT
-i
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
` 7 County Center Drive • Oroville, California 95965 Y Telephone (530) 538-7541 PERMIT O.
(Rev. 12/96) APPLICATION AND PERMIT X r0
ASSESSORPARC�L ER�
ZONING
BUILDINGPERMIT
GW
LZAP,
TELEPHONE
19W-3377
SO. FT. OCC. BUILDING VALUATION
OW, DS MAILJpIQ A;RES� / I
I�rJ[
C CT R'S NAM
�^
n5 ONE ��Hy�
3�
CONT TORS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 20.00
Permit Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDINGADDRESS 2 / n 3a �� C�
O
Energy Plan Checking Fee
$
$
PERMIT FEE
$
LOT
NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
Each Trap
7.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome )f Other
SPECIFY
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 ❑ Utilities ❑ Installation ❑ ,,Other ❑
Desicrib Work: l"^ n./1
LT
C
Gas piping system 1 - 5 outlets
15.00
Buildingsewer
15.00
Mobile Home I S I Go W
@20.00 ZO
PERMIT FEE
$ yb -
ELECTRICAL PERMIT
Fling Fee 20.00
Main Service 22000A oa 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 i full force and effect. n] l
D LIC. NO.
License Class /�� 1747
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale..
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
A 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.
T"have and will maintain w rkers' compensation insurance, as required by Section
3700 of the bor Code, o the performance of work for which this permit is issued.
My work compen - n 'sur nce c!!�n polic mbar are:
Carrier Cl.
Policy Numder
(The above section ee 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.
,,,A�QQ--
X �'/� Date 0
Signature of AUlicant - ❑ Owner $r -Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Main Service TO
46.00so
WEE200A
CCU000A
NEW CONST. DWELLING OCCUP. SO
OR ADDNS. ( a ACC. BLDS. 3.52Fr.
NEW CONST. MULTI.OUTLET
NON-RESID. @7.50
POWER APPARATUS
a SINGLE OUTLET CIR.
Ex. Occup. OUTLET OR FIXTURES BAL ®I.50
Ex. Occup. OFliiE°TSAWRESIo °ea 5.00
Temporary Service
23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE S
MECHANICAL PERMIT Fling Fee 20.00
Heating A
Cooling
Hood 6.50
Ventilation
PERMIT FEP_ $
Mobile Home Installation Fee $
Energy Inspection Fee $
occ CONST. TYPE
TOTAL FEE $ 110 00,
HAZ.
D. FLOOD I CDF PARCEL PD HD
IS E
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.
C ���%�
By ^� � /` Date Z
PERMIT EXPIRES ON Z' L g �L ool
ate
ReceiptNo. S? ®
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
USA W4 somm
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