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064-460-007
Sinclair Circle., Unit 6.,.Lot 105, P.P.1 Magalia Permit 2023-72P ~ ^ , / ^ � \ � - cfli mI- tet- cfli RESIDENTIAL' 064-460-007 PERMIT#96-0069 STAHL, John & Alyce 14273 Sinclair Circle, Magalia Cont; D & D Homes MH on Perm Fnd a- THE'HCD FORM 433A FOR THIS.MH CANNOT _ BE RECORDED UNTIL ONE OF THE.FOLLOWwING HAVE BEEN TURNED IN TO THE BLDG DIV: (1) LICENSE PLA.TE(S) (2) LICENSE DECAL MY STATEMENT OF F C S 1�`8J 415 • JOB FINALED (Date) Signature V=OK 0 = Not OKNot Applicable - '=NotReady MOBILE HOMES Date MOBILE HOME UTILITIES (Plans) OK except #'s 1. Zoning Requirements -Setbacks - Easements Date 2. Soils; Special MH Support Sketch Card B-1 3. Sewer; Location -Test -Fall -C/0 -Concrete Card B-1 4. Water; Location -Test -Easement Needed (Sketch) 5. Electricity; Location-Clearances-Gmd-/ /Amp -Concrete Date 6. Gas; Location-TestaNrap; / P'L'ft. / /Nat. or/ P'L'Yt./ /LPG 7. 411 Clearance & Disconnect . Ufility Clearance Date Card B-1 Date Card B-1 Date Card B-1 Date Card B71 Date MOBI OME INSTALLATION Plans OK except #'s o ' equirements- Setbacks Easements , S/rooytigs; bize•spaang-marriage une fYElectricity; MH Test -Crossovers -Breakers -Clearances% � _ a 5. Drai MH Test -Fall -Flex Connector . Water; MH Test -Regulator -Connector 7. ater and Sewer Connected -C/O to Grade -HD Approval r - as and Electricity Tagged 9 Downs -Type -Installation Cert. . 4 , MISCELLANEOUS - Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils-Size-DepthSpacing-Connectors-Steel 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts-Beams-Rftrs.-Connectors Shthg: Rfg: Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg.; Sils-AnchorsStuds-Rttrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -landings Date "]j 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-SVucture Stability . 3..Pool Structure; Steel-Connertions-Thickne'ss,,,,,.,,.,W 'Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distance -GR 5. Elec.; Pool Lighting; 15 Volts-GFI 7 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 1 7. Elec.; Bonding; Metal w/6 -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 J Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 DateZ Card B-1 Date Card B-1 . 4 , MISCELLANEOUS - Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements 2. Footings; Soils-Size-DepthSpacing-Connectors-Steel 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts-Beams-Rftrs.-Connectors Shthg: Rfg: Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg.; Sils-AnchorsStuds-Rttrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -landings Date "]j 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-SVucture Stability . 3..Pool Structure; Steel-Connertions-Thickne'ss,,,,,.,,.,W 'Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distance -GR 5. Elec.; Pool Lighting; 15 Volts-GFI 7 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 1 7. Elec.; Bonding; Metal w/6 -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 J Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 'J OK O=Not OK = Not Applicable Not Ready RESIDENTIAL" (Single & Duplex) ' = Date UNDERFLOOR (Plans) OK except k's 1. Zoning -Setbacks -Easements -Flood -Slope 2. Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 4. Ftg., 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 -Anchor -Regulator -Service Test 12. Electric; Underground 13. Pienums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples 15. Access & Ventilation 16. Insulation Date Card B-1 Date Card B -1 - Date Card B-1 Date Card B-1 Date PLUMBING (Permit),OK except n's 16. Wafer Htr.: Vent -Access -Combustion Air -Baffle ------------------------------------------- -- --------------------- 17. Water Pipe: Test & Anchor -Nail Protection ----------------------- --------- D.W.V.: Test -Fittings & Anchor -Nail Protection ------------------------------------------------ --- --- 19. Shower Pan: Test. First Floor -Tub Access ---------------------------- -------- ---------- --------------- 20. Test Tub & Shower. Second Floor -Tub Access ---------------------------------------------------------- ----- 21. Gas Pipe: Size & Anchors -------------------------------------------------------------------------------- Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date ELECTRICAL (Permit) OK except #'s 22. Fixture & Transformer Clearance -Ins. Protection -- --------------------------------------------------------------- 23. ------------------------------------------- ---------- 23 Elec. Receptacles Spacing -Lights & Switches at Doors ---------------------------------------------------------------- ---------- 24, Size Boxes & No. of Conductors -Stapled ---- -------------------------------------------------- --- - - -- 25 Romex Installed Close to Edge of Studs & CJ. ----------------------------------------------- -_. .. 26 Equip Ground made up w/Mech. Fastners-Bond Gas & Water --------- -------------- - --------------------- ------- - -- -- - 27. 2 Appliance Circuts in Kitchen & Conductor S ze,GFI ------------------------------------ ............ ... .. 28 Subfeed Wire Size ga. Cu or AI -A.0 Wire Size / ga -------------------------- Cu or At --------------- ---------- - -------------- .. 29. Range Circ r , ga. Cu or AI -Oven Circ. I / ga Cu or AL Insulated Neutral ❑ Yes ❑ No -------- ------------------------------- -- ............. .. 30 Service -Riser Conductors & Ground -Main Disconnect - - ............. ........ ........ .. 31. Equip Clearances Panels-Motors-Mech. Equip ---- ---- - --- - - ------ - 32 Clothes Closet Light -Shower Light -Spa Light --------- - ------------_------ --------- 33 Smoke Detector ------------------------------ -_ _ ----- ------------ -- Date Card B-1 Date Card B-1 --------------- ----- -------- ........ - ---------_--- - -- -----_--- .. ... ... ... Date Card B-1 Date Card B-1 Date MECHANICAL (Permit) OK except a's 34 A C. Ducts Insulation & Support ------ -------------- --- 35. Vent Fan: Exhaust above insulation -------------------- ---- --- .. ------- 36 Condensate Dram &Overflow. Size & Grade 37 Furnance-Vent: Access -Comb Air -Return Air Vent -115 outlet ---- - ----- 38 Attic Access & Platform if Furnance in Attic Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date FRAMING (Plans) OK except a's 39 Sits. Proper Material & Anchors 40 Walls Studs -Nailing. Spacing & Bracing -Plates -Sound . ..... . ... ... .. . _-- . . _.. ... .... . 41 Bearing Walls over Girders & Floor Nailing 42 Draft Stop in Walls (rat proof) 43 Fire Stops. Furred Ceilings- Sta irs-Chases-Tub -----------. ..... _ .. .._. .. 44 Headers & Beam -Size & Bearing Date FRAMING (Continued) 45. Hangers -Post Caps -Anchors -Connectors _ 46. Cing. Joist-Rftr. ties-Purlin-roof Brac-Truss-Shthng.-Rfng. 47. Fireplace Ties or Type A Flue -Fireplace Throat clearance ------------------- --- -- 48. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles -------------49.-Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions ----------- - 50. Garage Fire Protection Framing 51. Property Line Firewall & Openings -------------- 52. Ext. Doors -One 3 -Check Garage -3rd Story, 2 Exits -------- --------------------- 53. Stairs: Width -Headroom -Rise -Run -Landing -Fire Protection _ 54. plywood on Roof Overhang -Attic Vents -Rafter Outriggers ------------------ 55. Siding -Nailing Veneer ---------------------------- ----- 56. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access _ 57. -Glazing Area -Glass Protection -Skylights -Plastic 58. Shear Walls: Nailing -Bolts 59. Insulation -Walls -Ceilings 60. Infiltration -Walls -Windows .------------------------------------------- -- - Date Card B-1 Date__ Card B-1 Date Card B-1 Date Card B-1 Date FINAL (Plans) OK except a's 61-.- Ext. Steps -Door & Sidelight Protection -Landings ------------------------ - 62. Smoke Detector ------ ------- ------------------------------ - - 63. Furnace: Vents -Clearance -Comb. Air -Connector - n Garage: Above Floor-Ducts-Mech, Protection 64. Bedroom Exiting ..------------------------ -•-- 65 G.F.I & Bath Fixtures & Tub Access -Spa 66. Elec. Trim & Subpanel: Breaker Sizes & Labels -------------------------------- 67. Stags & Rails --- ---- ----------------------------------- 68 Fireplace or Stove: Clearances -Hearth .. ... __..------------------------------- - 69 Elec. Outlets at Wood Panel: Int. & Ext. - - - - •------------------------ --- --------- 70. Kit.Fixt. & Appliance: Grnd.-Air Gap -Cooking Clearance _.....------------------ -------- ---------- -- 71 Elec. Outlets & Receptacles at Kit. Counter 72. Garage Fire Door: Swing -Landing -Closer ..... ... .................. --------------- 73. A.0 Duct in Garage -Damper ...... ......._.... -. ------------------------------- 74. Wir Htr.. Vents -Clearance -Comb. Air-Connector-P.R.V. In Garage: Above Floor-Mech. Protection ..... --- ------------------------------- ---- 75. Plb.. Elec. & Mech. Equip" Listed for Location 76. Elec. Receptacles in Garage: (G.F.I.)-Romex Protection --------------------------------- 7, Insulation -Foam -Looked in Attic ❑, Yes --------------------------------------------- 78. Guard Rads & Deck Construction -Post Caps 79 Fdn Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes - - ------------------- --- 80 Following instld.,. Drive ❑ Yes ❑ No: Walks ❑ Yes ❑ No: Planters ❑ Yes ❑ No ---------- -------------------------------- ---------- 81. Stucco. Brown -Finish ' - - --------------------------------- 82 A C Unit: Disconnect. Electrical. Plumbing 83 Vents Above Roof. Plbg -Appliance-Fireplace.-Clearance to Openings ....... ..- - - - ----------------------------- ----------- 84 --------- -- --------------------------84 Water Well: Disconnect. Electrical. Plumbing - ---- ----------------------------- 85 Exterior Elec Trim. G F I. Receptacle -Underground 86 Ventilation Throughout House 87 Glass Protection - - --------------- 88 Corrections from Previous Inspections 89 Gas Test -Meters Tagged: Gas -Electric 90 Water & Sewer Connected-CrO to Grade -HD Approval 91 Energy Compliance Certificate -Other Certificates - --------------- - ------------------- Date -------------------------------- Date Card B-1Date Card B-1 . . .._ . ------------------------------ --------- Date Card B-1 Date Card B -t Date Card B-1 Date Card B-1 Comments at Final: e, I I- t'll-Z GOUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 .County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. APPLICATION AND PERMIT 96 _ ASSESSOR PARCEL NUMBER 64-46-007 r-1 ZONING BUILDING PERMIT OWNER JOHN (Olt ALYCE STAHL TTME2755 SO. FT. OCC. BUILDING VALUATION 84,240.00 OWNER'S MAILING ADDRESS 1364 AGATE LN PARADISE, 95959 CONTRACTOR'S NAME D Lt D H0iI1ES TEQNE3303 L I CONTRACTORS MAILING ADDRES 243 FEATHER RIVER BLVD OROVILLE, Fireplace CONSTRUCTION LENDER UNIDJOWN Total Valuation Is 84.240.00 Filing Fee $ 20.00 LENDER'S MAIUNG ADDRESS Permit Fee 576/9 $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ . ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 14273 SINCLAIR CIR PERMITFEE S PLUMBINGPERMIT Filing Fee 20.00 MAGALIA Each Trap 7.00 LOTNO. SUB tON'SNAME PARCEL MAP Solar or heat pump water heater 23.00 Water piping 15.00 15.00 USE OF STRUCTURE SF ❑ Duplex ❑ Mobilehome CK Other SPECIFY Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 15.00 Building sewer 1 5.00 15.00 TYPE OF WORK New CK Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other Describe Work: 3 BEDR00`1 2 BATT- 26 X 60 — PEMJANENT FOUNDATION Mobile Home I S I GI W 1 920.00 PERMITFEE $ 65.00 Contractor ELECTRICAL PERMIT Filinq Fee 20:00 STATE APPROVED SYSTEM EXIST. SITE Main Service OOOV OR LESS ( 200AOR LESS ) 23.00 Main Service ( 200A TO 1000A ) 46.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. !' License Class :' Z/7 Lic. No. 7 J/ j S•� OWNER -BUILDER DECLARATION 1 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, ormy employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ 1, 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 NEW CONST. DWELLING OCCUR OR ACDNS. ( & ACC. ) BO. 3.S¢ FT. NEW CONST. MULTI.OUTLEUTLE T NON-RESID. ( BRANCH CIRCUITS ) 97.50 POWER APPARATUS (a SINGLE OUTLET CIR. ) Ex. Occup. ( OUTLET OR FIXTURES ) 20 Q 1.00 �L FIXED APPWS.OR Ex. Occup. (OUTLETS (RESID.) EA ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMITFEE g 43.00 Contractor WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier 2,e .i .'J -L MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Policy Number ,N3 72 D GO (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. X 1J�Date=moi � Signature of Applicant - ❑ Owner 9 -Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee Is OCC CONST. TYPE OTAL FEE $ 439.00 HAZ. I D. FE IMP FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under of the Butte County Code and/or indicated above for which fees have By PERMITEXPIRESON the applicable provisions Resolutions to do work been paid. Date ,(4f/rL (Dal) 190786 — 247.00// t�� Receipt No. � �% �����' WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -I SPECT R GOL ENROD-APPLICANT ti..jl'h....-r'....3,.,,.i"r.-�•-'.. r�rn.^•,��".n-•SZ~:rvJn'.n-r�...t'i'1��ryur,�'%''r' �r.,.-..M*... .-. .^'rf4rYlr'f.iw.., r^ :...tib,. .r • +, rhr r.r. , COUNTYOF BUTTE - DEPARTMENTOF.'MENTSERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 -TELEPHONE (916) 538-7541 PERMIT APPLICATION DATASHEET OWNER �D�%w1 jr- A"' Ll c`2. �TC' � Proposed Building Use /Y! �l?'� 6= . At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. All items have -been submitted . ........................................ 2. Plot plans, 3/4 sets, signed by preparer of plans. t 3. complete plans, 3/4 sets, signed by preparer..of plans. . 4. Engineered plans and calcs, 3/4 sets, with wet signature on plans. .. .. . 5. Hazardous Material Form. ....... . 6.' Energy Design Compliance and suppo ing documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). .... »_ 9. Mobilehome�aia and_manufacturer's installation instructions, 2 sets. .......... Feesof $........................ .................. l- 3 11. Impact fees as shown on attached schedule . .............................. 12. California Department of Forestry plan approval/fees. ......................... ' 13. Flood elevation letter (100 year flood) by California Engineer. . . 14. Sanitation and plot plan approval inWic-AD Health Department. ........ ...L11- -l6 _ 15. City of Chico plumbing permit. ....... . 16. Plot plan and business license approval Irom City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: 18. Contact Land Development about (A) Improvements (B) Drainage. ........... 19. Driveway permit (construction approval required prior to occupancy). .. . est 20. Pre -inspection for required. .. o Building sped- (Date) 21. Contractor's license information. (No., Name Style, Classification) . .............. 22. Certificate of Workmans Compensation Insurance . ........................... 23. Owner -Builder Verification (Given to owner Mail to owner ............ 24 -.'-Recorded copy of Agricultural Acknowledgement Statement .................... 25. Letter of signature authorization . .........................................` 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use . ........................................ . 28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access . ..................... :.................. 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . .................................... 32. Plan lis . ..... . 33. IM X33 �si,�Pa�r�� pa�u c.�.�.�........ X34. f, G y a v o rr When you issue the er ' "process as follows: Mail tQ owners Mail to contractor. Telephon` _ . ? n and hold for pickup at Y O V 4« office. Deliver with inspector. Parcel Creation Acreage Applicant Date / R 'S.S Copy of Hai -Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other . Date By The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: Co4 11 ntractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone _ mai C m ter• _Date Plans checked by Date Plans approved by Date �p Sets of plans on hold -in---- ..Eile•cabinet AP folder Copy_- Department of Public Works f , w...w' TO: Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance a.H. USE ONLY Plat Plan Aj;a I l Y C� Poor Plan Auached Seat to B.D. ! — fig _ ��_ (�tz�'rxt, a4 d S /Y S -c yyo-o Owner Location AP# Plan Approved for: Sewage Disposal Water Supply: Public Private Well Clearance for 3 bedroom mobile home. Other Hold final for: Final clearance O.K. for: NOTE: Environmental 8/92 COUNTY OF BUTTE DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE, OROVILLE CA 95965 TELEPHONE (916) 538-7541 OWNER Jc�'��J s-�� A.P.' # D o 7 PROPOSED BUILDING USE JVI; NI rp-eIM w.� p�.f � k�,�a bio.✓ DATE CJ REC. # DATE REC nn - P SCHOOL DISTRICT FEES (paid at District Office) 2. SHERIFF FEES (paid at Building Division) Residential...... x _$ unit amt. ; Commercial' (sq. ft.). x =$ 3. URBAN AREA FEES` (paid at Building Division) Residential (per unit). x =$ #units amt. Commercial (sq.ft.). x =$ sq.ft. amt. 4. RECREATION DISTRICT FEES (paid at District Office) 5. THERMALITO DRAINAGE DISTRICT FEES $400.00 (paid at Building Division) 6: SRA FIRE INSPECTION AND - PLAN CHECK $89.00. (paid at Building Division) 7. WATER TENDER FEES (BATTALION # ) ` $200.00 (paid at Building Division) 8. CSA 87 TRAFFIC FEE $2500.00 (paid at Building Division) , + 9. OTHER At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. APPLICANT / DATE---�._ n ,, =Return to: AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENT r� :;uildinga Division _ FOR RESIDENTIAL DEVELOPMENT. r Section 26-8.1 of the Butte County Code requires this _ acknowledgement be recorded prior to, issuance of a building C:0�01 894 r permit.. r r { The property described herein is adjacent to land or included r within an area zoned for agricultural purposes, and 'residents _ of this property may be, subject to, inconveniences or discomfort arising from the use of 'agricultural chemicals, including, but 'not limited to lierbicides, pesticides, and r J 1 fertilizers; and from the, pursuit of agricultural .operations including, but not limited to cultivation, plowing, spraying, pruning; and barvesting which occasionally generate , dust,smoke,. noise, and odor. Biitte•County has established , agricultural zones which have as a priorityuse for. productive agricultural purposes and residents within said zones and,on adjacent property should be prepared to accept such inconvenience or discomfort from normal, necessary farm operations.` All that real property situate in the County of Butte, State of Cali fornia,ldescribed as follows: ". Date: -,:)"- PROPERTY OWNS S: � f -I T/4 hA a /(2 - State of Califo ua County ofu On �— .5 yS•. before —me, f7 \FOIQ [ personally appearedFlo SiCL. � \ C�.d�ci -1. 6. S +ak personally known to me (or proved to me on the basis of satisfactory evidence) to be the persons) whose names) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized , capacity(ies),'and that by his/her/their signature(s) on the instrument, the person(s), or the entity upon behalf of which the person(s) acted, executed the Instrument. _ WTiNESS my hand and official seal, a Tl1R61 J. GUDGEON Comml slon in 50724 POIr CPS1 Nolary Public Signatur Seal,, t3utloCounty. Calilornia my C .fid» A.P. a_7 BUTTE COUNTY SCHOOLS -IMPACT, EE CERTIFICATION FORM (One Form Per Building) School District Pa- S Building Department No A.P. Number Jurisdiction: 0 City Property Owner Property Location/Address `4 72-7 3 S% N c e-4 w/ Subdivison Lot No. 0 County Residential Development ER No. of Living MHI Units Commercial/Industrial '-`' -,LXy °. I New Building Department Rep -District Identification No. qu _ 00q LkC Uchool District certifies that Address) ity) .i Sq. Footage Addition (Group R) Sq. Footage �itioA (Including Exterior �7 Roofed Areas) 5?— 7L Date 'ersohnel) (Applicant) ?V 21 x" ! (Phone Number) has complied with the requirements of Resolution No, by payment of $ representing �� square feet. AB 2926 $ rn I ti ^ FULL MITIGATION $ HUI., )I District Paid by Check # Bank Number _ Paid by Cash Date Remarks:C`�Y)% 2&0 C(X-- ' , ,Cb(n') L4e GL UA0 If, subsequent to the Sc ool District Representative signing this Butte County Schools Impact Fee Certification Form,. .the School District is notified by the applicable Local Planning Agency that this project �0 is being reviewed under the California Environmental Quality Act (CEQA), this project may be subject to additional school fees to fully mitigate its impact on the school district's schools. White (applicant), Yellow (building department), Pink (school district) reerorm.wk, (11/94)dmm 1. r - Sq. Footage Addition (Group R) Sq. Footage �itioA (Including Exterior �7 Roofed Areas) 5?— 7L Date 'ersohnel) (Applicant) ?V 21 x" ! (Phone Number) has complied with the requirements of Resolution No, by payment of $ representing �� square feet. AB 2926 $ rn I ti ^ FULL MITIGATION $ HUI., )I District Paid by Check # Bank Number _ Paid by Cash Date Remarks:C`�Y)% 2&0 C(X-- ' , ,Cb(n') L4e GL UA0 If, subsequent to the Sc ool District Representative signing this Butte County Schools Impact Fee Certification Form,. .the School District is notified by the applicable Local Planning Agency that this project �0 is being reviewed under the California Environmental Quality Act (CEQA), this project may be subject to additional school fees to fully mitigate its impact on the school district's schools. White (applicant), Yellow (building department), Pink (school district) reerorm.wk, (11/94)dmm 1. s RECORDING REQUESTED BY: AND WHEN RECORDED MAIL TO: BUILDING DIVISION NAME 7 COUNTY CENTER DRIVE OROVILLE CA 95965 STREET ADDRESS CITY, STATE and ZIP -006937. I96-006937 I96-006937 1 Recorded I Official Records I County of I Butte I Candace J. Grubbs I Recorder I 2:01pm 26 -Feb -96 I Rec Fee '-.00 Total .00. f COMS XX 2 SPACE- ABOVE THIS LINE FOR RECORDER USE ONLY NOTICE OF MANUFACTURED HOME (MOBILEHOME) OR COMMERCIAL COACH, INSTALLATION ON A FOUNDATION SYSTEM Recording of this document at the request of the local agency indicated is in accordance with California Health and Safety Code Section 18551. This document is evidence that such local agency has issued a certificate of occupancy for installation of the unit described hereon, upon the real property described with certainty below, as of the date of recording. When recorded, this document shall be indexed by the county recorder to the named owner of the real property and shall be deemed to give constructive notice as to its contents to all persons thereafter dealing with the real property. JOHN W AND ALYCE R STAHL REAL PROPERTY OWNER/LESSOR 1364 AGATE LANE MAILING ADDRESS PARADISE, BUTTE, CA 95969 CITY COUNTY STATE ZIP 14273 SINCLAIR CIRCLE INSTALLATION MAILING ADDRESS, IF DIFFERENT MAGALIA, BUTTE, CA 95954 CITY COUNTY STATE ZIP SAME UNIT OWNER (If also property owner, write "SAME'l MAILING ADDRESS CITY COUNTY STATE ZIP BUTTE COUNTY BUILDING DIVISION LOCAL AGENCY ISSUING PERMIT and CERTIFICATE OF OCCUPANCY 7 COUNTY CENTER DRIVE MAILING ADDRESS OROVILLE, BUTTE, CA 95965 CITY COUNTY STATE ZIP 6-0069 (916) 538-7541 UIL T NO. TELEPHONE NUMBER 2/26/96 SIGNATURE OF LOCAL AGENCY OFFICIAL DATE NONE DEALER NAME (If nat a dealer sole, write "NONE'l DEALER LICENSE NO. UNIT DESCRIPTION FLEETWOOD 1996 5604B MANUFACTURER'S NAME DATE OF MANUFACTURE MODEL NAME/NUMBER SN18315A&B 60'X26' RAD870454/870455 SERIAL NUMBER(S) LENGTH X WIDTH INSIGNIA/LABEL NUMBER(S) A.P. #064-46-0-007 REAL PROPERTY LEGAL DESCRIPTION ASSESSOR'S PARCEL NUMBER SEE ATTACHED LEGAL DESCRIPTION. NT OF' Q HCD FORM 433(A) Rev, 8/91 WHITE—County Recorder CANARY—HCD PI!IK—Apphcant GOLDENROD—Budding Dept. Order No.: 3-54460 SD LEGAL DESCRIPTION EXHIBIT ."ONE- The land herein referred to is situated in the State of California, Butte, and is described as follows. Count y of Lot 105, as shown on that certain, map entitled ',PARADISE PINES UNIT 6", filed in the office of the County Recorder of.'Butte County, California, on August 26, 1970, in Book 35 of,-Maps, pages 92, 93 and 94. EXCEPTING THEREFROM all minerals, oil, g substances; with provision that any And all miningtoperationseshall bedrocarbon from orifices outside the surface $area of the land herein described, and that no damages shall be done to the'surface of said land. (A.P. No. 064-460-007) 9 rnn i End..of Legal on7n 1 0 n I C !17I 'NVVJ 77111 Al 7I In(I 71):CT InU1109 II_ 'AIHP NUMBER: 96-0069 BUILDING PERMIT Address or location of unit: 14273 SINCLAIR CIRCLE,,: MAGALIA -Legal Description of Real Property: A 'P • #064-46-0-007 SEE ATTACHED LEGAL DESCRIPTION. [X]Mobilehome/Manufactured Home [ ]Commercial Coach Has been affixed to the real propertyabove by installation on a foundation system pursuant to Health and Safety Code Section 18551. Owner's name:' ° , JOHN . W AND ALYCE R STAHL Owner's address: 1364 AGATE LANE, PARADISE, CA .95969 • ` ' RAD870454/870455 INSIGNIA OF HUD NUMBER: SERIAL NUMBER OR V.I.N. SN18315A&B t• MANUFACTURER'S NAME: FLEETWOOD 1996 `-OFFICIAL•APPROVING INSTALLATION: DATE: 2/26/96 PHONE: (916) 538-7541 H.C.D. 513C } RECORDING, REQUESTED BY: Butte County Title Company When Recorded Mail Document ' and Tax Statement To: f John W.'stahl• Alyce R. Stahl 14273 Sinclair Circle Magalia, CA 95954 Escrow No. 354460-WC,'Title' Order No. 54460 54460 1 ;• APN: 0 6 4 - 4 6 0 - 0 0 7 SPACE ABOVE TMiS LINE FOR RECORDER'S USE ONLY JPN _ GRANT DEED The undersigned grantor(s) declare(s) _ Documentary transfer tax is $ 35.75 City tax $ [ xx ] computed on full value of property conveyed, or [ ] . computed on full value less value of liens or encumbrances remaining at time of sale, [ xx]• :Unincorporated Area City of t FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Winfred Birch Zimmerly and Betty Frances Zimmerly, Trustees of the W. B: & E. F`. Zimmerly Family 1988 Revocable Trust dated March.14,'1998 hereby GRANT(S)to John W. Stahl and Alyce` R. Stahl, husband and wife, as Joint Tenants the following Tdescribed real property in tlt Kjaf the unincorporated area of Magalia I County of Butte - -State of California: See legal description attached hereto and made a part hereof DATED: January 09, 1996 ,+ -_• ` ' STATE OF CALIFORNIA - COUNTY OF Butte winf reld B Zimme �l , ON January 10, 1996 before me, ;.�' .✓ nlstee Wendy Cser personally appeared �E Birch Zimmerly and Betty Frances Betty Frances mme Trustee Zimmerly, 1 personally known to me. (or proved to me on the basis of satisfactory, evidence) to be the person(S) whose name(s) Is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same f • �1111IIIIIUt111U11111111111111111 t1111I1111111111t111IWO1�WIW1■ in his/her/the(r authorized capacity(ies), and that by - OFFICIAL SEAL - his/her/their slgnature(s) on the instrument the person(s).. 9988,2 D or the entity upon behalf of which the person(s) acted,, N J 1NEtvDY CSER M M y NOTARY PUBLIC • CALIFORNIA 0 r executed the instrument t COUNTY OF o6lTrt MY Commission Expl roe June 27,1897 W �rtlumultnra:nunannlhmamurntnuunnunucrimu • WITNESS my hand and official seal Signature �� MAIL TAX STATEMENTS AS DIRECTED ABOVE FD -213 (Rev 3/94) GRANT DEED inn .l 60`7n ir,o nTa•11a1 1li An. 1i;i`n'a T.n-cI InUllnc. r1_ �iun %. `vP o t LEGAL DESCRIPTION Order No.; 3-54460 SD EXHIBIT "ONE" The land herein referred to is situated in the State of ' California, Count -of Butte, and is described as follows: Y Lot 105, as shown on that certain map entitled "PARADISE PINES UNIT 6", filed in the office of the County Recorder of'Butte County, California, on August 26, .1970, in Book 35 of Maps, pages 92, 93 and 94. EXCEPTING THEREFROM all minerals oil g - substances' with provision that any and all miningtoperationsum'aneshallrbeadbon from orifices outside the surface area of the land herein described, and that no damages shall be''done to the surface of said land. (A.P..No. 064-460-007) f End of Legal _ rnn 1 0070 ir0 nTc;9131 NvNJ 7x1111 Al 7IIn0 7n`CT (OU i►0a IT_AINA DEPARTMENT OF STATE 00 DIVISION OF CODES -ANO STANDARDS —REGISTRATION—ANO—TITLING SECTION - STATEMENT OF FACTS This unit.is.a:� Mobilehome Commercial Coach =:- 0 Floating Home Truck Camper Decal .(License) No.(s) Trade -'Name . Serial.No.(s) - - - • ,U . 3/ _ I/We, the undersigned; hereby•state_that.the unit described above: .;.1-�• `Y•�vv �(�/Cl !/��95 '/v �dC2 �� �r/(J -• •�/�J�ST6'X�/ !��'. .. a Affiant furtheragrees•to indemnify and save harmless the Director of Housing and Community Development,.State of California, and subsequent purthaser.s•of said unit, ,for any loss.they may suffer resulting from registration of the above-described unit in California, or from issuance of a --California certificate -of title covering the same. I/We certify -under penalty of perjury that the foregoing is true and correct Executed on`ellat ����i//e L __—(Date) (City) (State) Signature of each affiant- Address,'- ffiant ri' y f Printed name of each affiant Address,'- Y' el? e,�� 4914-1a -City,'�%�� ` . +. State �� HCO 416.6 (Rev 11/86) OWK 'R-' S NAME- PROPERTY AME:PROPERTY ADDRESS: /y ASSESSOR'S PARCEL #: SCALE: I 3i TIlL N FR 6/1 L 7,q CA. qS 9S L t Ac ,cL iN6 ® I60, Re fIAC .•...y,T - - - - , s --o 0 J :J7 yATtk rArTL,k Environmental Health JAN 1 6 1996 Chico, Califomia APPROVED Butte County Environmental Health Da Bsgn.aW € AIS se of pions arta specit;icdtians MUST th*. kept on t e job cat o@I.-•1IMes End it is. unlaw+ful.,*x.- or ani cvitarc�s y. or ¢altort.si•ioris oil some eaithou+ � wr-inert P�rrrsassic►� $roma •!•I�`© �3eia,ar9•m.enfi��.Ptak�• ` Works, ,ounty of Butte. %IC�iE•--�:II� ��-.��e?•mals �; �a'ta,k:�ta«,�:5�, �i:cl! �3 �? 6 is a 63 i;. ya ? t�„�. i• aE r ';�.. y•. A6 � •Q�_�€,t;e� o�t:�:. .....: �f .=i'u`y::� _ _�::� rs8 fsE" lE c::.?'e t("�' i..@J iil li'?e �Ji.?'J'!C ; ^2 wi "E+- '�� i � f51.11 i� F.i ?'- �La li<..li l; -x•.:.33 ?w!�G16`e'� ?lie f' ci ion, 14d1. STRUCTURES AND EQUIPSENT INCLUDING BUTTE COUNTY OVERHMGS SHALL 13 : C Ea_� � r� ���- �;�^ SET i3 ;%i< OF� _. ., Q 01 F111, �i, �s � �' _�D BUILDING DEEP: -A Ti` ENT �s i=i. o-=ROl�9 a ; �t •;�-�" -,:Y .•r, -..,r 5 �I I Pi �� {ipoe� �® ��!pp^-�� !E i—`kt^ L o ¢` JEgtr ; ! L Ark' ■ O F! D ,.ti,L c u F CLEAR OF STRUCTURES� C �/��t�- l C4jl'�R e OVERHANG. APPROVED ; e� Butte County �.. Environmental Health Environmental -Health m / Uj -JAN 16 1996` . ate o Chico, California t, LO � n p z E- �. t4W UA8 I G.YO I �/ Cur 1•,L. 00 1 I I L opoics rri,z- 1`'- 0 � Q p I ,, etMN 36, -ZL. - ir s! ALI. Piz. tArsCL w- Cr. .2A . Ln s I! LU L e, IlIR1i I�. I (ALFA 1 ; F; 6246 � 7d�6 i BU . x. - DATE 8Yi ) --SC27Pi(UN lEt 1D . • S.Y. ' FLEV1001) '�-� VUUbLANU '* &I Sr.. LINE OWING lyoliU51560411 [ N GF 1 .MH.L- 2 A.. . IL�O�'.:...::...:..............................:::::::::.:::::::..::::::::::::::.:::::.:::::::.::. Mobilehome Manufacturer: lrleel- w®a Manufacture Year: �( t If other than single wide;- furnish Setup Model Number: Width:aG (ft.) Length: . 60 (ft.) Tagalong or Expando Size (ft:) x (ft.) On all mobilehomes manufactured after October' -7, 1973, ' furnish manufacturer's installation manual and structural setup sheets. } FOOTINGS: Wood pressure treated or foundation grade[64 Other: SUPPORTS: Concrete block] Other: Provide Tie Down Specifications for all Mobilehomes: 5 yL� Pier Footings Sizes and Location SINGLE WIDE +; MULTI-WIDE ' Line 1 Line 1 Line 2 Line 2 . r - Main Beams ...................................................... ................... .. ......... Line 2 ... ine 2 Line I + • Line 3 Line 2 .............................. .................................................................... Main Beams{ .............................'.................................................................... Line 2 _ Line 1 i • Tag or Triple ' ine 4• , ............................... .' ine 1 r. Line 1 Piers: Line 1 Openings Size minimum: r, ix r i.`` Size minimum:' x [RRA. - ,Spacing maximum: ----`— Each side of openings From ends-maximum:1 with width over. Line 2 Piers: Line 4 Piers: Size minimum: [a y ] x Dy ]` ' Size minimum: Spacing maximum: Spacing maximum: ` From end's-maximum] From ends-maximum: ` Line 3 Roof Loads:- Size minimum Location (from*ont): .- �•• 3 _ - .8.: ' Line 5 Roof Loads: Size minimum: Location (from front): A a i � GNOUN . tl .� .� OVER -t3U1Ll.-11UEPARTENI 1. Owner's Name: ,Lo 4 ,C-� _5,ygW11 2. Assessor's Parcel Number: O6 y- zip D — 0®';, 3. Installer's Name:U� D /�p,�r'�� . 5 3,,� - 330 3 4. Is the site currently under permit? Yes[ ) No[A Permit No. 5. Is the site an existing site? Yes[XI No[ ] (If yes, furnish two plot plans). 6. What is the electrical rating of the mobilehome? /,Q,0 Amperes. 7. What is the mobilehome site circuit breaker rating? a Oe-, Amperes. 8. What is the electrical rating of the mobilehome site? 41 Do' Amperes. 9. Is the main service remote from the mobilehome site? Yes[ ] NoP4 If it is, what is the rating? Amperes. 10. Is there any other electric load to be served by the mobilehome site electric service (i.e. well, garage etc.)? Yes[ ] No[9(],Ifyes, please identify the load and size: a) The mobile home site: Load- Amperes - b) The main service: Load- Amperes - 11. Type of gas service at mobilehome site: Natural[ ] Propane[,{) None[ ] 12. Size of ...gas pipe at the mobilehome site from the meter or tank: 3 inches. 13. What is the gas pipe length from the meter or tank to the mobilehome? (ft.). 14. What is the mobilehome gas demand? B.T.U.* *(This information is not required if the pipe length is less than 6 feet on natural gas or less than 50 feet on propane). THE OTHER SIDE OF THIS FORM MUST BE COMPLETED IN ORDER TO PROCESS THIS PERMIT APPLICATION - I- May 1995 8.5 Permit: 2023-72 P r HAWKINS' ' JACK /, Sinclair' Circle Unit 6 ` Lot 105 PP (Gas sve. only) COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — Oroville, California 95965 Telephone: 53:-14230, Ext. 259 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. P Signature of Permitee or Agent Date Receipt No. White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -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 Building Permit Expires Date BUILDING Owner SQ. FT. OCC. BUILDING VALUATION Mai I i ng Address Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Permit Fee $ $ Building Address PLUMBING No.1 @ FEE PERMIT FILINGFEE $2.00 - Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 A. P. No. Zoning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .50 Fire Zone Fire Dept. Sanitation Planning Building sewer 5.00 Plans Fees W. C. R/W Encroachment Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ OTHER ❑ Permit Fee $ $ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service incl. 1 meter Additional meters, each 1.00 Sub -panel (12 or less) (more than 12) USE OF STRUCTURE Single Family ❑ Duplex ❑ Others ❑ Range, dryer or water heater 1.00 Oven, Cook -top or space heater 1.00 Light fixtures Receps., switches & fix outlets 20 P 25 CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: Hood, Ex. Fan or F.A. Furn. Motor 1.00 Evap. cooler, gar. disp. or D.W. 1.00 Air conditioner or heat pump Water pump Misc. wiring License No. Classification ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. ❑I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation 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 $Permit Ir strumentao o�rrPr a Motion $0.07/$1000 Evaluation $ TOTAL PERMIT FEE $ till authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. P Signature of Permitee or Agent Date Receipt No. White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -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 Building Permit Expires Date Owner 7 MaiIio_ ddress COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 05 r %Z 7 County Center Drive Orgville, California 95.965 Telephone: 533-1230, Ext. 259 n APPLICATION AND PERMIT „ BUILDING -- _ SO. FT. T OCC. BUILDING VALUATION C Contractor' ' & ' / Mailing Address "Q /gAz, / ,,e d Building Address A. P. No. Fire Zone Fire Dept. Sanitation Plans Fees I W. C. R/W NEW ADDITION ❑ Zoning A- 2 Plannin Encroachment OTHER ❑ USE OF STRUCTURE . Single Family Duplex ❑ Others ❑ Fireplace Total Valuation Permit Fee Plan Checking Fee &/or Penalty Permit Fee $ - PLUMBING No.1 @ FEE 3,SD PERMIT FILING FEE ` $2.00 Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1:50 Each gas water heater or vent 1.50 Gas piping system 1 - 5 outlets 1.50 "?, Each additional outlet .50 Building sewer 5:00 Lawn sprinkler system 2.00 Permit Fee ELECTRICAL PERMIT FILING FEE Main service incl. 1 meter Additional `meters, each Sub -panel 02 or less) (more than 1: Range; dryer or water heater Oven, Cook -top or space heater Light Nxtures Receps., switches & fix outlets CONTRACTORS LICENSE LAW Hood, Ex. Fan or F.A. Furn. Motor I am licensed under the provisions of Chapter 9. Div. 3, of the Evap. cooler, gar. di-sp. or D.W. State California Busine s & Professions Code and r the name Air conditioner or heat pump Water pump Misc. wiring 1 6 License No. Classification - !� ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee MECHANICAL WORKMEN'S COMPENSATION INSURANCE PERMIT FILING FEE I am aware of the provisions of Section3700 of the California Labor . Heating Code wh' requires every employer to be insured against liability for Wo men's Compensation. I have placed on file with the County of Butte a certificate of Cooling Workmen's Compensation Insurance. I certify that in the performance of the work for which this Ventilation permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of Cal f @ FEE $3.00 III i orm a. 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 authorize representatives of the County of Butte to enter upon the above-mentio ed property for inspection purposes. X f Date Signature of•Permiteer-o7r Agent Receipt No.�lf\ White-D.P.W. — Pink -Inspector — Goldenrod -Assessor — Yellow -Applicant f Fee ee or Str�rn gram g Motion ee for n $0.07/$1000 Evaluation $ to F TOTAL PERMIT FEE $ 31.100 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 DatecP,- 7-`i~? Z Building Permit Expires Date P-2-1—!3