HomeMy WebLinkAbout064-330-02364-33-23 -
ermi�s�°1 is 15-7�9�'° Ct�1�,FIH}P`� 0ara 1
ELEC. - 46w #0
-
GA S
j SUPPORT STRUCTURE REQ_. 1�
f COMPACTION TEST REQ..
64-33-23
Contr: Para`diso�r Modular Concepts
Permit #3116-79MHI
Issued 41
64-33-23
Contr: Cal GA s, Paradise
D.ermit #3398-•79P(•gas -line-
(
line°
r,
o i !
S
i
k
f
. J)
1
RL
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive Oroville, California 95965
Telephgrle: 534-4541
APPLICATION AND PERMIT
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
`.,
r '
Signature of Permitee or Agent
Date' _
Receipt No.
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 PUBLIC WORKS
By r Date
Building permit expires Date
I
BUILDING
Owner t
SQ. FT. OCC. BUILDING VALUATION
Mailing Address J
Telephone No.
Contractor
Mai lin Address ' �j
9 I ., ,'S. � �� `t I�
Fireplace
Total Valuation
r
Telephone No.
i.r�_�j %,•.
Permit Fee
Building Address
Plan Checking Fee&/or Penalty
Permit Fee
PLUMBING No.1 @ FEE
Y r�
PERMIT FILING FEE $3.00 7 .• ,
Each Trap 1,50
Repair drainage or vent piping 1,50
A. P. No. - c/ ' — , -;
Zoning & Planning
Water piping 1.50
Each gas water heater or vent 1.50
Fees
W.C.'
'Parking
Sanitation
Fire Dept.
Fire Zone
Use Permit
Gas piping system 1 -5 outlets!.c �, 1.50
EQA
Plans
Parcel
Declaration
Parcel Ma p
60' R/W
Improvements
p
Each additional outlet .30
Building sewer 5.00
Bldg. Plans -Redd
Parcel Approval
Plans Approval
Lawn sprinkler system 2.00
NEW E] ADDITION ❑ UTILITIES ❑ OTHER ❑
Permit Fee $ (o
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
600V OR LESS
Main service 100 AMP OR LESS 5.00
Single Family ❑ Duplex Mo 1Iome thers
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 CONS. I DWELING
OR ADDNST % ACCLBLDGS.Ccup- '>:') 22sgft
CONTRACTORS L
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business_& Professions Code under the name
style of:
NEW CONSTR /BRANCH TLET CIRCUITS) NON •RESI T 1 BRANCH CIRCUITS/ 2.50ea
NEW CONSTR. POWER APPARATUS 6
NON RES D. SINGLE OUTLET CIR.
Ex. OCCUP(OUTLETs OR FIXTIIRES) g �2j
FIXED ALNS
Ex. Occup.(OUTLETSP(RESID.)REA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. h 7� Classification r. 2 e)
Misc. Wiring6.25
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
MECHANICAL No. @ FEE
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
E]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 relatinq to buildinq construction, and hereby
Land Development Fee
$
TOTAL PERMIT FEE
$ I
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
`.,
r '
Signature of Permitee or Agent
Date' _
Receipt No.
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 PUBLIC WORKS
By r Date
Building permit expires Date
I
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive1. - yroville, California 95965
Telephone: ,5 u 4541 00 9P
APPLICATION AND PERMIT VVV
Owner�Lwt�
Mailing Address
Contractor (11A 0
Mai I i ng Address
Building Address
ITelephone No.
Telephone
d-nv
A. P. o. (01 �j� � 3 Zoning & Planning
F s lon I Fire Dept. FireZone Use Permit
EOA I Plans Parking I Declaration p p Parcel Parcel Ma 60' R/W I Improvements
Parcel Approval Plans Approval
NEW ADDITION ❑ UTILITIES ❑ OTHER ❑
Single Family ❑ Duplex ❑
LPG,
Mobi I Home
_L / A
Others ❑
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:
License No. 3112-1 W Classification C A
❑ I am exempt from the Contractors License Laws of the State of California.
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
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
California.
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
authorize representatives of the County of Butte to enter upon the
above- on d property f inspection purposes.
Date 4_
Receipt No!`S-V7-3 6
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
BUILDING
FT. OCC. I BUILDING VALUATION
Fireplace
Total Valuation
Permit Fee
PI anChecking Fee&/or Penalty
Permit Fee
PLUMBING
PERMIT FILING FEE
Each Trap
Repair drainage or vent piping
Water piping
Each gas water heater or vent
Gas piping system 1 - 5 outlets
Each additional outlet
Building sewer
Lawn sprinkler system
Permit Fee
BAL 10y
ELECTRICAL
PERMIT FILING
FEE
Main service
600V OR LESS
100 AMP OR LESS
Main service
EA. ADD'L 100 AMP
Main service
OVER 600V
100 AMP OR LESS
Main service
EA. ADD'L 100 AMP
NEW CONST. /
OR ADDNS. 1
DWELLING OCCUP. 5
ACC. BLDGS.
NEW CONSTR.
.n.P- qIn_
(MULT1.OUTLET
` BRANCH CIRCUITS
$3.00
5.00
2.50
25.00
1.00
Ex. OCCUP(OUTLETS OR FIXTIIRES
BAL 10y
Ex. Occup. (FIXED LNS
OUT ETS P(RES(D.)REA)
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wirina
6.25
Permit Fee $
MECHANICAL No. @
PERMIT FILING FEE
Heatina
Cooling
Ventilation
Hood 1 1 2.00
Permit Fee $
Land Development Fee $
TOTAL PERMIT FEE $
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 PUBLIC WORKS
By:e� Date Sr'- 7!j
Building permit expires Date.-5� ��
i^ 2 PERMIT NO. 1615-79P,E
PERMIT-EXPIRES
„ ,OWNER Paradise Modular Concepts
owner
CONTR.
. LOCATION (A.P. 64-33-23
10 Creston Rd., Lot 57, PP4, Magalia
All
V;
ear s
�" FY
Temp. Power Pole
Called PG&E
,Temp.•.Elec. Serv. M,
. , Called' PG&E1/0 —')
-y Tenip. Gas,Serv.
CaII.- d PG&E
JOB t 1
d/ FINALED 1
(Date)
1'
v
(Signature)
9. Electrical
A. Is service large enough to provide adequate amperage -to mobilehome (must equal rating of
mobilehome with a minimum,o 100"amp-) and.,;other facilities on lot, i.e., water pumps,
garage, cabana, etc.? Yes No
- ° . _ .. 'gym . _ :�s... - •
B. Is there proper clearances around panels? Yes No
C. Is power supply cord or feeder assembly properly•fu`sed? Yeas 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. t
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 no carrying metal parts -of the mobilehome (aluminum siding, gas line,
water'line), including fixtures and appliances, shall be tested for continuity from
such equipment and the grounding conductor.
6. Upon completion of the above.procedure, the power supply cord or feeder assembly
conductors shall be connected to the site service equipment. A further continuity
test shall then be made between the grounding electrode and the chassis of the
mobilehome. -Upon satisfactory completion of the electrical tests, the lot or site
service equipment may be approved for energizing.
10. Is job card signed by Health Department for water and sanitation?
11. If everything okay, sign off card and tag services,
MOBILEHOME DATA
Manufacturer and/or Namestyle
Length Width,2
Vehicle Serial. No.
5
MOBILEHOME INSTALLATION 'INSPECTION CHECK LIST
1. Is the mobilehome locate .w th 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)X e1P s`- No
3. Are footings and_supports properly sized, spaced, and braced s per approved plans? (Note
possible variation at spring shackles.) ( e 5082 & 5083) Yes No
4. Is the mobilehome level? (Sec. 5088) Yes No_
5. If morp than a single unit, are crossover connections properly installed? (Sec. 5088)
Yes�o_
6. Watery
A. Islrxible connector of adequate size and properly -installed (1/2" ID min.)? (Sec. 5566)
Yes " o
B. Test - Does wa er piping withstand working pressure or 50 -lbs, air to - No
C. Backflow— f coach is not State of California approved, does station have backflow device
and pressure- lief valve? Yes No
7. Wastes and Drains
A. Is connection made with Schedule 40 DWV and have flex connectors at each end? es No
B. Does it have minimum 4" per foot slope and is it properly supported? Y s_ No
C. Are any leaks detected in drainage system after rudh_in lions of water through each
fixture including washing machine standpipe? Yes N%�
D. If c0_17
o h is of State of California approved, does station have required trap and vent?
Yes N
8. Gas Piping an Gas Vents
A. Connector - Is mobilehome connected to the gas supply with an approved 3/4" minimtmi
mobilehome connector not more than 6 ft. long? Note: All piping is to be at least as
large as them b'lehome gas line inlet without reductions other than the mobilehome
connector. Yes No
B. Test OK as per ollowing procedure? Yes_ 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 No_
t
COUNTY OF BUTTE —'DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECThON RE -CORD
BUILDING BUILDING (Cont'd) PLUMBING
Sefkack FXewall I Sllil Piping
For PaNpets t Floor
Mai Idg. Restr m Finish 2nft loor
Foo 'n s Window 3rd F or
Stem II Siding To out
Slab Roof Sheatkpg Water Pi in
Piers Roofing Sewer
Garage Fdn. Vents X Fixtures
Footings Garage Vents Water Htr.
Stemwa l l Insulation Heaters
Slab Prov. for physically Appliances
handica ed
Carport Conformance of ex-
Footings
x. Gas PI in &Test
Footin s structure Temp. Gas
Slab Final Sanitation
Patio FIREPLA Final
Footings Footing ELECTRIC,%L
Masonry Walls Throat Rough
Reinf. Steel Final Fixtures
Bond Beam FIRE SPRINKLERS Motors
Framing Test Water Htr.
Stucco Final Subpanels
Mesh MECHANICAL Gird. Fault Prot.
Scratch Heating Service
Brown Cooling Temp. Pole
Finish Ducts Underground
Interior Lath Ventilation Permanent
Door Closer Final Final
MOBILEHOMEU ILIT ES ------------------ Elec. Service AP Elec. Pedestal
Water Piping 3 7 14 1Sewer y Gas Piping
BI E OME NTA CATION Support 77MMIL. Elec. Continuity y,
Water Piping p I CJ 1 Drainage - %i o,y. l Gas Piping
DATE REMARKS OR CORRECTIONS
l �,,./ tee. 14
6PA&AA ,J /'/
�c
(NOTE: An entry must be made on this form each time you visit the job site.)
a
f
r
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 _%/6 /Y for the following location:
/ C1 '1_4
Owner //� �� '%C
Owner's Address
d
Mobilehome Mfg. W Model Year -79
Insignia No. J (� f l-�lSerial No.
It is hereby certified for occupancy at the above described location and
may be occupied.
Director off%Public�Works
Date � �f �� � By
THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATE
White- Owner, Yellow- Installer, Pink - D.P.W.
COUNTY OF BUTTE _,QEPARTMENT OF PUBLIC WORKS
.f 7 County Center Drive — Oroville, California 95965
Telephone: `534-4541
APPLICATION AND PERMIT
Owner L
Mailing A ress .
Telephone No.
Contractor /
Mai I i ng Address
Building Address `Q
A. P. No. 6 AA
— 3 �r `
3
1 PT—.J,ng
& Planning
F
S
License No. 7/ Classification
ire Dept.
Fire Zone
❑ I am exempt from the Contractors License Laws of the State of California.
Use Permit
EQA
Parking
Plans
Parcel
Declaration
Parcel Ma p
60' R/W
Im rovements
p
Bldg. P s RecdParcel
oval
Pla s royal
NEW ❑
ADDITION ❑
UTILITIES ❑
OTHER ®�
,gip
Single Family ❑ Duplex ❑
Mobi I Home � Others ❑
_ BUILDING
SQ. FT. I OCC. I BUILDING V UATION
Fireplace
Total Valuation
Permit Fee
Plan Checking Fee &/or Penalty
Permit Fee
PLUMBING
PERMIT FILING FEE
Each Trap
Repair drainage or vent piping
Water piping
Each gas water heater or vent
Gas piping system 1 - 5 outlets
Each additional outlet
Building sewer
Lawn sprinkler system
Permit Fee
ELECTRICAL
PERMIT FILING FEE
Main service 6001 OR LESS
100 AMP OR LESS
Main service EA. AOD•L 100 AMP
Main service OVER 600V
100 AMP OR LESS
Main service EA. ADD'L 100 AMP
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 - A
(,�_
•tee"
ULTI-OUTL T
NEW CONSTR./MCU
NON.RESI D, l BRANCH CIRITS
NEW CONSTR. (POWER APPARATUS E
NON-RESID. SINGLE OUTLET CIR,
Ex. Occup{OUTLETS OR FIXTIIRE
EX. Occup ( FIXED APPLTS (RE S, OR
OUTLETS (RESID) EA
mporary service
Mobile Home Facilities
License No. 7/ Classification
Misc. Wiring
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee
MECHANICAL
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 ;0Wor en's Compensation.
have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
I t' f th t' th f f th k f h' h th'
PERMIT FILING FEE
Heating
Cooling
$3.00
1.50
1.50
1.50
1.50
1.50
.30
5.00
2.00
$3.00
5.00
2.50
25.00
1.00
2.00
10.00
15.00
6.25
$3.00
FEE
FEE
LJ c., I y a In a per ormance o e wor or w Ic Is Ventilation
permit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws ofHood 1 1 2.00
California. Permit Fee $ is
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
x.zr�rr�, (f�1�i_sG/7�Date
Signature of Permitee or Agent
Receipt No.
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
Lan yJ% _3O, 0
TOTAL PERMIT FEE $ 3 pQ
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.
DIR .C- OF PUBLIC WORKS
r
yla�AJIA
Date
Building permit expires Date
BUTTE COUNTY . DEPARTMENT OF PUBLIC WORKS
7 County Center Drive, Oroville, CA.
.... PHONE:.534=4541., ..:.. .. _ '
MOBILEHOME INSTALLATION`SHEET
1.
Owner's name:
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.)
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 / L,L_� No
(If no, clarify.
)
(
)
5.
.What is the mobilehome electrical rating?--.----------
/ a o Amps
6.'
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
r
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,/
11.
What is the gas pipe length from meter or tank to th mobilehome?
12. :What
is the mobilehome gas-demand? -----=-'--------=------=------
,..
F
(BTU)
'
t
(This information not required if..pipe leng h less thani6 fto atural gas
or less than 50 ft. on LPG.)
P
B AEHOME SUPPORT DATA
4 If other than single wide,
Mobilehome Mfr. /�,�_ furnish Setup Model No.—��� Year1 1%
Width o2 C2 (ft.) Box Length 'S`-0' (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)
Single
Ea", . Wood either
AA pressure treated or
foundation grade.
(ft.)(in.) (in.) (in.) 2. Other (specify)
Center support Center support
locations* footing sizes Supports (check one)
(in.)
l: Concrete block.
E] 2� Other (specify)
(ft.)(in.) (in.) (in.)
4---Tagalpng or Expando,'
show support details.
(ft.)(in.) (in.) (in.)
/.� x3 -- Typical Support
(in.) (in.) Footing Size
32 D �30
(ft.)(in.) (in.) (in.) (-- Max. Pier Spacing
(ft.) (in.)
Max. Overhang
(ft.) (in.) (in.) (in.)
(ft.) (in.)
BUTTE COUNTY
BUILDING'DEPARTMM
A P P ryo V
*If Tenter piers are other than drawn above,
draw in-locatigns, spacing, and dimensions.
COUNTY OF BUTTE �— DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — O,oville, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
autrlonce representatives of ine vounty of t5mte to emer upon ine-
above-mentioned property for inspection purposes.
X ate
Signature of Per;4e or Agent
Receipt No. 1
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.
DIRECTCR.OF PUBLIC WORKS
By Date q—y_,72
wilding permit expires Date y— it—.Ra
BUILDING
r( Z��. J �
Owner /4-QL
�vl S�� Ddu
SQ. FT. OCC. BUILDING VALUATI N
Mai I i ng Address
Telephone No.
p — —�!
Contractor tr avL
.
Mailing Address
Fireplace
Total Valuation
Telephone No.
Permit Fee
Building AddressPlan
Checking Fee&/or Penalty
Permit Fee
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00 tC>a
Each Trao 1.50
Repair drainage or vent piping 1.50
A. P. No. — 3 -"
1Zdhing & ing
Water piping 1.50
Each gas water heater or vent 1.50
s
ul[vG. S ' n Fire Dept.
Fire Zone
Use FVrmit
Gas piping system 1 - 5 outlets 1.50 �, a
EQA
Parking arcel
Plans Declaration
Parcel ap
60' R/W
Improvements
Each additional outlet .30
Building sewer 5.00
Bldg. P ans Recd
Parc Approval
Plans Approval
Lawn sprinkler system 2.00
NEW ❑ ADDITION ❑ UTILITIES OTHER ❑
Permit Fee $ 3r3 co$
ELECTRICAL No.1 @ FEE
PERMIT FILING FEE . $3.00
Main service 600v OR LESS/meq
100 AMP OR LESS 5.00 / vv
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. OR ADDNS. ( ACCLBL GS.DWELING CCUP. 4) 20sq 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:
NEW CONST'z BRANCH CIR T
NON-RESID. (MULTI,O BRANCH CIRCUITS) J2.50ea,
NEW CONSTR. (POWER APPARATUS 6�
NON-RESID. SINGLE OUTLET CIR.
Ex. Occup (OUTLETS OR FIXTIIRESi g L 251 1@
Ex. Occup. ( OUTLETS PIRESID )REA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00®�
/ /
License No. O`?� % f $ Classification C _
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.
EyI 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
$ :t�—,Q(
TOTAL PERMIT FEE
$
autrlonce representatives of ine vounty of t5mte to emer upon ine-
above-mentioned property for inspection purposes.
X ate
Signature of Per;4e or Agent
Receipt No. 1
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.
DIRECTCR.OF PUBLIC WORKS
By Date q—y_,72
wilding permit expires Date y— it—.Ra