HomeMy WebLinkAbout065-040-003LOT I BLOCK
TYPE OF I PERMIT NO. PLAN NO.
PERMIT
PERMIT DESIGNATION:
DEPARTMENT OF
_I BUILDING AND SAFETY'
AP 65-04-03
JOBB,, E.L. _ //p2/7yG
STREET�w/s Hupp Cofitolenc Rd, 4 mi . past
end of Black Top
Permit#$ 4012-74B(garage, MH)
AP -J
03
JBDIV.
E.L. COBB
lot 3, Coutelinc Estateon Hu p'
DATEISSUED Coutelinc,Rd,, Paradise_oontr: Illumination Elo Para.
Permit# 4675-74E (new sub -panel '&
wiring on garage) s
-AP 65-04-03
Permit#>� 4.69-75B(ramada, MH �� 3"7-�
B -BUILDING
P -PLUMBING
T -TRAILER
065-040-003 PERMIT#97-0031
MARTIN, Bonnie
6720 Hupp Coutolenc', Magalia
Cont: Morehouse AC 11q1q7
Gas Line/MH
E -ELECTRICAL U -USE PERMIT
TV -RADIO-TV ANTENNA V - VARIANCE
S/W-SIDEWALK NOTICE S_ SIGN PERMIT
REMARKS
HM -HOUSE MOVING
EP - ENCROACHMENT
D - DEMOLITION 600.1
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LOCATION,
FORMS,
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STEEL
FRAMING
INTERIOR
LATH
EXTERIOR
LATH
INTERIOR
PLASTER
EXTERIOR
PLASTER
CONCRETE
BLOCK
GARAGE
FIREWALL
FIREPLACE
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AND WHEN RECORDED MAIL TO:
BUTTE COUNTY BUILDING DIVISION
7 COUNTY CENTER DRIVE
OROVILLE, CA 95%5
Recorded
Ufficial Records
CoBUUTTT Of
CANDACE J. GRUBBS
Recorder
ROSEMARY DICKSON
Assistant
09:16AM 13 -May -2003
REC FEE 7.00
CONFORM 1.00
Cheryl
Page 1 of i
AGRICULTURAL STATEMENT OF ACKNOWLEDGMENT
FOR RESIDENTIAL DEVELOPMENT
Section 26-8 of the Butte County Code required this acknowledgement to be recorded prior to issuance of a building
permit. The property described herein is adjacent to land or included within an area zoned for agricultural purposes,
and residents of this property maybe subject to inconveniences or discomfort from the use of agricultrual chemicals,
including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations
including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust,
smoke, noise, and odor. Butte County has established 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 California, described as following:
Lot 8, as shown on that certain Map entitled, "COUTOLENC ESTATES SUBDIVISIN UNIT NO. 1", filed
in the Office of the County Recorder of Butte County, California, on November 12, 1969, in Book 35, of
Maps, at Page(s) 35, 36, and 37.
Date -0 3 PROPERTY OWNERS:
�&
( / Jade Kent
State of California
County of Butte
On -Mda ' A 00,3 before me,
1—hq- aQ
personally appeared Vee. 4C/U? pof9eftally kne "'?-
mo-(er proved to me on the basis of satisfactory evidence) to be the person(o) whose name(s) te is/asubscribed to the
within instrumentand acknowledged to me that ke/she/Fiey executed the same in hWher/tkek authorized capacity(ios)
and that by his/her/their signatureH on the instrument, the person(,or the entity upon behalf of which the person(4
acted, executed the instrument.
WITNESS my hand and official seal.
M. SUSAN GLATZ
COMM. # 1280664
Signature Seal:' BNOTARY PUBLIC-CAUFORNIA
COUNTY OF BUTTE
Comm. Expires Oct. 16, 2004
A.P. # 065-040-003
C -P*
065-040-003 PERMIT#97-003f '-
MARTIN, Bonnie
6720 Hupp Coutolenc, Magalia
Cont: Morehouse AC
Gas Line/MH
OFFICE COPY
Address
GAS Datq �;z "
Meter By
ELECTRIC Date
Meter By
I - -- ...-., .. '-Y"n.++c ct 'T"i . �a '^t�l�`r(7�.T!"'3tk 196i`.t" �•e� .. �,,,,p�.�.TA�'� ��"�PF�' °"
COUNTY OF BUTTE- DEPARTMENTAF DEVELOPMENT SERVICES -BUILDING DIVISION
7 .County Center Drive -,Oroville; California 95965 - Telephone (916) 538-754 PERMIT NO.
APPLICATION AND PERMIT 1 9�7-0031
b'•av
ASSESSOR PARCEL NUMBER 065—(i40-003 _
ZONING 'j'M ,5
BUILD NG PERMIT
OWNER BOINWIE MARTIN
TELEPHONE
SQ. FT. OCC. BUILDING
VALUATION
OWNERS MAILING ADDRESS 6720 HUPP COUTOLENC .RD MAGALIA
CONTRACTOR'S NAME MORE HOUSE AC
T t�.b�-9100
CONTRACTORS MAILING ADDRESS 905 8TH ST ORLAND; 95963
Fireplace
P
"t .
CONSTRUCTION LENDER .,
UNKNOWN
Total Valuation $
Filing Fee
$ 20.00
:
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$ •. .
ARCHRECT OR ENGINEER'S MAILING ADDRESS
_
Penalty
$
BUILDINGADDRESS 6720 HUPP COUTOLPJC
PERMITFEE
$
PLUMBING PERMIT
Filing Fee 20.00
14AGALIA
Each Trap
7.00
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
Solar or heat pump water heater
23.00
Water piping
15.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome Y] Other
SPECIFY
Each gas water heater or vent
15.00
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑X
Describe Work: GAS PIPING/MNACE
—
Mobile Home ISIWI W1
U•00
920.00 2U
PERMITFEE
S 40_00
Contractor
ELECTRICAL PERMIT
Filinq Fee 20.'00
Main Service e00V OR LESS
( 20oA OR 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. LLn (%
License Class e � Lic. No. S 3 J - Y '7
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, 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
NEW CONST. DWELLING OCCUP.
OR ADONS. ( a ACC. )
soBLDS.
3.51t FT.
UTLE
NEW CONST. MULTI -OUTLET
NON-RESIO. ( BRANCH CIRCUITS )
@7.50
POWER APPARATUS
( a SINGLE OUTLET CIR. /
EX. Occup. OUTLET OR FIXTURES
( )
20 Q 1.00
�L 50
FIXED APPWS. OR
Ex. Occup. ( OUTLETS (RESID.) EA)
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMITFEE
S
Contractor
WORKERS'a COMPENSATION DECLARATION
I hereby affirm under penalty,,%of perjury one of the following declarations:
❑ 1 have and will maintaincertificate 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.
8111 have and will maintain workers compensation insurance, as required by Section
3700 of the Labor Code,'for tte performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy num er are:
Carrierr�- 0A1)1 AEALA �J0—rAF ' 1 IJIU�
�
MECHANICAL PERMIT
Filing Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMITFEE
S
Contractor
Policy Number O/ —. / ? Gt AJ11- 0,00 ;�?'7C—
(The above sections needAnot.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 Rr 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 �j„r!/�� /!(�%L�ar,Date _ / .�� _
Signature ofyApplicant - . Owner ❑ Contractor ❑ Agent / r
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 $
OCC
CONST. TYPE
TOTAL FEE $ 40.00
HAZ.
I D. FEES
IMP I FLOOD
COF PARCEL PD HO
SSUE
This permit is hereby issued under the
of the Butte County Code and/or
indicated above for which fees have
B y
PERMITEXPIRESON
I
applicable provisions
Resolutions to do work
been paid.
Date/—Lf--?7
t — �— /00k
(Date)
Receipt No. 209648
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
�4
1( Alteration, Addition or Conversion,
Department of Housing and Cemmawty Developmem
Division of Codes and Standards
APPLICATION FOR
D
D Altemats Approval, D Technical Services,
IEE REVERSE SIDE OF FORIN FOR INSTRUCTIONS AND ADI
CONTRACTOR/OWNER BUILDER DECLARATIONS
Nor rsqulmd for Spec/of Purpose CommemW Coaches or
Rscmdona/ Vehle/as
1. LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 70001 of Dli islon 3
of the Business and Professions Code; and my license le In fug forte and
effect. `�[/
License Class -) / f Llc. No. .J .J' 7 Exp. Date'
Contractor i'yrI' M6Y'P 11,1.1 Date
2. OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 am exempt from the
Contractors License Law for the following reason (Sec. 7031.5),
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure,
prior to its issuance, also requires the applicant for such permit to file a
signed statement that he or she Is licensed pursuant to the provisions of
the Contractors License Law (Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code) or that he or
she is exempt therefrom and the baste 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($SOO ):
I 11. as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not intended of
offered for sale (Sec. 7044, Business and'Professions Code: The
Contractors 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, provided that such improvements
Ore not intended of offered for sale. If, however, the building or
improvement is sold within one 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 I, as owner of the property, em exclusively contracting with licensed
contractors to construct the project ISec. 7044, Business and
Professions Code: The Contractors License Law does not apply to an
owner of property who builds or improves thereon, and who contracts
for such projects with a contractor(s) licensed pursuant to the
Contractors License Law.).
I am exempt under Sec. , S. & P.C. for this reason:
Owner Date
3. WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 II have and will maintain a certificate of consent to self -insure for
workers' compensation, as provided for by Section 3700 of the Labor
„ode, for the performance of the work for which this permit is issued.
i 1 1 have and will maintain workers' compensation insurance, as
;squired by Section 3700 of 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
Policy Number
'This section need not be completed if the permit Is for one un re
collars (51001 or lessl•
11 certify that in the performance of the work for which this permit is
.ssued, 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
;hould become subject to workers' compensation provisions of Section
3700 of the Labor Code, 1 shall forthwith comply with those provisions.
Applicant Date
WARNING: FAILURE TO SECURE WORKERS C PO4SATION
:OVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO
:RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
rHOUSAND DOLLARS (9100,000), IN ADDITION TO THE COST OF
:OMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF
rHE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
t. CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there Is a construction
ending agency for the performance of the work for which this permit is
ssued (Sec.3097, Civ. C.).
-ender's Name
-ender's Address
I certify that 1 have read this application and state that the above
nformation is correct. I agree to comply with all city and county
-)rdinances and state laws relating to building construction, and
lereby authorize representatives of this county to enter upon the
:�ove-mentloned propegy for Inspection purposes.
—�`6ate
SECTION 1 • UNIT INFORMATION
D Replacement Insignia/Label .:
I/We are regtreaUrtp sarviees for the following unit(al: k. ..
(Check Approprim Box)
anu'actured Home/Mobilshome,
Manufactured Homa/Mobilahome Component Structure
Reereatlenal vehicle
Commercial Coach (Occupancy Group _J
Special Purpose Commercial Coach
Decal or License No.
Serial
Manufacturer Name/ r f't� I�
Model Name 1� ULU r-! ES
Insignia/HUD Label Number(s)
COL No, 4ivA1 /7
FEE RECD
DpyTE �d'� � 7 /&/-b�=
AA NO.
RT TO {
RT BY __ C/ Z//Cr h
Year of Manufacturer
Owner f� /1 /�/ / T IU.YT T \
Address �A / Ly /7V PP �C�fTi!J��E hyc� Q e-1
City / Y 0 Cat( ll County t' LJ_ u \ e_ zip
Location Address
>A. 0A
Applicant
Address
City ZIP Telephone No.
SECTION 3 - CONTRACTOR, ARCHITECT OR ENGINEER INFORMATIO
�N
—
Coiltt tor'sName Morekou�� Alr,tr��QNl�t_C(%t�l�pilt —Edc-
Aadresat qC� ��Ie, yid l'l Sf c �v�CCI�l l'/t C%S�ile ?
Architect/Engine'er Name C-;_11k['11_'.5eLicense No.
Address
12
C
\ �I.C�7k
Describe the proposed work/activity in detail. Attach additional pages if necessary. Where structural
alterations or additions are proposed, complete plans, specifications, details, and calculations are required to
be attached to this form. Provide the make and model of any appliance to be installed and provide complete
electrical calculations for any electrical alterations or additions.
I`- (11,4;1064e. �l� t./ Jlcil^F O� C:t�':IL. c.
!LK__ �l�C/ .Old ter. /i�r r c, l '
• f � U!(>�JeC/ <� - r • 5 •./ lr •I /•/: ; 1, r'", ;._
G
Indicate the Total Cost of the Work to be Performed
AND
I/We hereby make application for the services designated above. If applying for replacement of a lost
Insignia or label for the unit described In Item number t above, I/we certify that there have been no
alteration, additions, or modifications to the unit which would affect compliance with California or federal
law or the rules and rags a of the Department. (Where alterations or modifications have been made an
Inspection man obte
Signature Date Z11 7X,1
DEPARTMENT USE ONL
PPROVED _✓ 171 CON ITIONS (see reverse side)
Signature -of
:0 415, Side 1 (10/94) DISTRIBUTION: YELLOW - DEPARTMENT, WHITE - AREA
❑ Disapproved (see reverse aide)
\Z• 1i °1�1p
Date
Te ~ - COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVI N
7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-75 PERMIT No.
APPLICATION AND PERMIT "7-®0a
ASSESSOR PARCEL NUMBER 065-040-003
ZONING TIM 5
BUILDrNG PERMIT
OWNER BONNIE MARTIN
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS 6720 HUPP COUTOLENC RD MAGALIA
CONTRACTOR'S NAME MORE HOUSE AC
E9100
CONTRACTORS MAILING ADDRESS 905 8TH ST ORLAND, 95963 -
Fireplace
CONSTRUCTION LENDER
UNIWOWN
Total Valuation $
Filing Fee
$ 20,00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
Penalty
$
BUIL.DINGADDRESS 6720 HUPP COUTOLENC
PERMITFEE
$
MAGALIA
PLUMBINGPERMIT
Filing Fee 20.00
Each Trap .
7.00
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
Solar or heat pump water heater
23.00
Water piping
15.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome 11 Other
SPECIFY
Each gas water heater or vent
15.00
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑X
Describe Work: GAS PIPING/FURNACE
—
Mobile Home S G W
@20.00
PERMITFEE
$ 40.00
Contractor
ELECTRICAL PERMIT
Filina Fee 20:00
'
Main Service 000V OR LESS
( 200A OR 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 ful force and effect.
License Class Lic. No. �3s�
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
NEW CONST, DWELLING OCCUR
OR ADDNS. ( a ACC. BLDS. )
SD.
3.5¢ FT.
NEW CONST. MULTI -OUTLET
NON-RESID. ( BRANCH CIRCUITS )
@7.50
( POWER APPARATUS )
& SINGLE OUTLET CIR.
Ex. Occup. ( OUTLET OR FIXTURES)
20 @ L.00
�� Se
Ex. Occup. ( OUTLETS I ES D.) EA)
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMITFEE
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.
t3 I 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 num are:
Carrier �� CD � I� lI Ti /1 A)—y-y17S+ A
�/6
MECHANICAL PERMIT
Filing Fee 20.00
9
Heating
Cooling
Hood
6.50
Ventilation
PERMITFEE
$
Contractor
�I�.�CTL[11/L
Policy Number O/� — & 1. AJr Undo ?-:Z6--Mobile
(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 mate _ —
Sign ure oYApplicant - Owner ❑ Contractor ❑ Agent
An dSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Home Installation Fee
$
Energy Inspection Fee $
OCC
CONST. TYPE
TOTAL FEE $ 40.00
HAZ.
I D. FEES
I IMP I FLOOD
I CDF
PARCEL
I PO HD
SSUE
This permit is hereby issued under the
of the Butte County Code and/or
indicated above for which fees have
By /
PERMITEXPIRESON
I
applicable provisions
Resolutions to do work
been paid.
-1 e-�'7
Date (� G
(Date)
Receipt No. 209648
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
.,..w v�.wnerrea
Business. Transportation and Housing Agencya
00
Department of Housing and Comhfunity Development
Division of Codes and Standards '
APPLICATION FORt""' .
lJ Alteration, Addition or Conversion, O Alternate Approval, D Technical Services, . 13 Replacement Inslgnili/Label
(SEE REVERSE SIDE OF FORM FOR INSTRUCTIONS AND ADDITIONAL iNFORMATION)
CONTRACTORIOWNER BUILDER DECLARATIONS
Not required /of Special Purpose CommeMe/ Cosches of
Recnet/ona/ VeAlc%s
1. LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I em 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.
Ucense Class LiAcnNo. .J / /`� Exp. Date'
Contractor' r ` 1Y \ pY'P I�l.r'.! + Date / t'
2. OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors Ucense 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 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 1 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 of
offered for sale (Sec. 7044, Business and'Profeasions Code: The
Contractors 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, provided that such improvements
are not intended or offered for sale. If, however, the building or
improvement is sold within one 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 11, as owner of the property, em exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business and
Professions Code: The Contractors License Lew does not apply to an
owner of property who builds or improves thereon, and who contracts
for such projects with a contractor(s) licensed pursuant to the
Contractors License Law.).
! ) I am exempt under Sec. , B. & P.C. for this reason:
Owner
3. WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 II 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.
I I I have and will maintain workers' compensation insurance, as
,squired by Section 3700 of 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
Policy Number
!This section need not be completed if the permits for one hundred
lollars ($100) or less).
I 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 workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
Applicant Date
WARNIN :FAILURE TO SECURE WORKERS COMPENSATION
-OVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO
-RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
rHOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF
:OMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF
rHE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
3. CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction
ending agency for the performance of the work for which this permit is
ssued (Sec.3097, Civ. C.).
Lender's Name
ender's Address
SECTION 1 - UNIT INFORMATION
VWe are requesting services for the following unttla): IL
(Check Appropriate Box)
anufactured Home/Mobilehome,
Manufactured Home/Mobilehome Component Structure
Recreational Vehicle
Commercial Coach (Occupancy 'Group _ I
Special Purpose Commercial Coach
Decal or License No.
Serial
Manufacturer Name/
Model Name u64U m is
Insignia/HUD Label Number(s) Z ��
•fir
USE'�ONLY�.'
Coo �l�/✓.ya'U
FEE RECD
DATE^','i
AA N0.
FIT TO
RT BY
Year of Manufacturer
Owner /'/ `►1(,( j/T� r\
Address -_ & 72.0 /7V Ply O.-, . L )if n0- R CI
City Mn < 1 l -L CounCty.CT�1.l Zip
Location Address 6A. -al
Applicant
Address
City
ZIP Telephone No.
SECTION 3 - CONTRACTOR, ARCHITECT OR ENGINEER INFORMATION
C,j(t��ctor'sNamme M0V'le Ouse Air Conn-tt mac, SBC.
Aadresa` Le, (a y�� l-1 S -f- U�yl�c ���. , Ca c1591G
ArchitectlEngineer Name �� +-1�� L'✓e�ICL'��cense No.
Address \ 4 .Ccwi
Describe the proposed work/activity in detail. Attach additional pages if necessary. Where structural
alterations or additions are proposed, complete plans, specifications, details, and calculations are required to
be attached to this form. Provide the make and model of any appliance to be installed and provide complete
electrical calculations for any electrical alterations or additions.
(air,
L
Indicate the Total Cost of the Work to be Performed 3 J1 1�?
1/We hereby make application for the services designated above. If applying for replacement of a lost
Insignia or label for the unit described in Item number 1 above, I/we certify that there have been no
alteration, additions, or modifications to the unit which would affect compliance with California or federal
law or the rules and reg u s of the Department. (Where alterations or modifications have been made an
Inspection mus outs
J
Signature r Date
I certify that I have reed this application and state that the above
nformation is correct. 1 agree to comply with all city and county
ordinances and state laws relating to building construction, and 7ErJCPPROVEDlereby authorize representatives of this county to enter upon the 13:�ove-mentioned proper>y for Inspection purposes.
of
:D 415, Side
(see reverse side)
13 Disapproved (see reverse 'side)
TA .444
Date
PERMIT NO. 4012-74R
w p
1
E
r
f M
f,
;MH UTIL.
'PERMIT NO.
t PERMIT EXPIRES
r OWNER E.L. Cobb
i
CONTR.
ILOCATION (A.P. 65-04-3 )
w/s Hupp Coutolenc Rd, a mi. past end of
blacktop.
01.
i
N
Temp. Power Pole
Called PG&E
Temp. Elec. Serv.
Called PG&E
Temp. Gas Serv.
Called PG&E
JOB
FINALED
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION RECORD
BUILDING BUILDING (Cont'd) PLUMBING
Setback 4
44, .. Firewall
Soil Piping
Forms
Parapets
1st Floor
Main Bldg.
Restroom Finish
2nd Floor
Footings
Windows
3rd Floor
Stemwall
Sidinq
To out
Slab
Roof Sheathing
Water Piping
Piers
Roofing
Sewer
Garage
Fdn. Vents
Fixtures
Footings
Garage Vents
Water Htr.
StemwaII
Slab
Prov. for physically
handicapped
Heaters
Appliances
Carport
Footings
Conformance of ex.
structure
Gas Piping & Test
Temp. Gas
Slab
Final Z —7
Sanitation
Patio
FIREPLA E
Final
Footings
Footing
ELECTRICAL
Masonry Walls
Throat
Rou h
Reinf. Steel
Final
Fixtures
Bond Beam
FIRE SPRINKLERS
Motors
Framin C I I
Test
Water Htr.
Stucco
Final
Subpanels
Mesh
MECHANICAL
Grd. Fault Prot.
Scratch
Heating
Service
Brown
Cooling
Temp. Pole
Finish
Ducts
Underground
interior Lath
Ventilation
Permanent
Door Closer
Final
Final / — / 7 — %
DATE
REMARKS OR CORRECTIONS_
4
1",N.
0/ C'< /�, C , a? /- -) W b, - ,, 41"
��.2GJ�jj I,v, Gf �7/�✓" l� �P� lA�ifN �� �i cam- .�<uc Ycr til
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WOR
7 County Center Drive' '—'Oroville, California 95965
0,Telephone: 534-4541
,iAPPLICATION AND PERMIT
Owner L A
Mailing Address art
/ elephon No.
Contractors 4? �—
Mai I i ng Address
Telephone No.
Building Address C) E'1t_
P
3 �A•c.�! fin) � _ r
/s �LL
A. P. No. 6 V y /'
Q Zoning & Planning
Fe'Fekf W. . San o FireDept. FireZone Use Permit
EQA Parking Parcel Parcel Ma 60' R/W Im rov ments
Plans Declaration p p
Bldg. Plans Rec'd I ParceVVr val F PI. Approval
NEWADDITION ❑ UTILITIES ❑ OTHER ❑
Single Family ❑ Duplex ❑ Mobil Home Others
C -A tL A. a e -
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. Classification
I am exempt from the Contractors License Laws of the State of California.
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.
LrV N 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.
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 �_� Date 9�/
Signature of Permitee or Agent
Receipt No.
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
BUILDING
SQ. T. OCC. I BUILDING V
1-n 0, F n .
Fireplace
$
Total Valuation
No.1 @ FEE
Permit Fee
$3.00
Plan Checking Fee &/or Penalty
Permit Fee
$
PLUMBING
No.1 @
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
j 1.50
Gas piping system 1 - 5 outlets
1.50
Each additional outlet
.30
Building sewer
5.00
Lawn sprinkler system
2.00
TI
FEE
Permit Fee
$
ELECTRICAL
No.1 @ FEE
PERMIT FILING FEE
$3.00
Main service incl. 1 meter
Additional meters, each
1.00
Sub -panel (12or'less) (more than 12)
Range, Cook -top or Oven
1.00
Water Heater or Space Heater
1.00
Light fixturesbald
Receps., switches & fix outlets
lo
Hn
Hood, Ex. Fan or F.A. Furn. Motor
1.00
Evap, cooler, gar. lisp. or D.W.
1.00
Air conditioner or heat pump
Water pump
Mobil Home Faciliiies
5.00
Temp. Power Pole
5.00
Misc. wiring
Permit Fee $
MECHANICAL No. @ FEE
PERMIT FILING FEE $3.00
Heating
Coo I i
Ventilation
Hood 2.00
Permit Fee $
TOTAL PERMIT FEE I $
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECTOR 0 PUBLIC WORKS
) 7
By Date 10 —
Iding permit expires Date kt.— 7 S
......................
III
1-41
PERMIT NO. 469-75B
A '7 -1-7�5
E
M
MH UTIL.
}PERMIT NO.
PERMIT EXPIRES c�2 -A)o 76
'OWNER E.L. Cobb
t'CONTR.
LOCATION (A.P. 65-04-o3
w/s Hupp-Coutelenc Rd., 4 mi. past end.
of Blacktop, Magalia
.. 4 �
0
-A
Temp. Power Pole
Called PG&E
Temp. Elec. Serv.
Called PG&E
Temp. Gas Serv.
vCalled PG&E
'JOB j 7
FINALED
(Damp
(S V ature)
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION RECORD
BUILDING
BUILDING (Cont'd)
PLUMBING
Setback
Firewall
Soil Piping
Forms
Parapets
1st Floor
Main Bldg.
Restroom Fini
2nd Floor
Footings
Windows
3rd Floor
Stemwall
Siding
To out
Slab
Roof Sheathing Al
Water Piping
Piers
Roofing
Sewer
Garage
Fdn. Vents A
Fixtures
Footings
Garage Vents
Water Htr.
Stemwall
Slab
Prov. for physical
handicapped
Heaters
Appliances
Carport
Footings
Conformance f ex.
structure
Gas Piping &'Test
Temp. Gas
Slab .
Final
Sanitation
Patio
FIREPLACE
Final
Footings
Footing
ELECTRICAL
Masonry Walls
Throat
Rough
Reinf. Steel
Final
Fixtures
Bond Beam
FIR SPRINKLER
Motors
Framing
Test
Water Htr.
Stucco
Final
Subpanels
Mesh
4 M ER44 I C A L
Grd. Fault Prot.
Scratch
Heating
Service
Brown
Cooling
Temp. Pole
Finish
Ducts
Underground
Interior Lath
Ventilation
Permanent
Door Closer
Final
Final
DATE REMARKS OR CORRECTIONS
Y��
. COUNTY OF BUTTE - I)EOAF(TMENT OF PUBLIC WORKS
7 County Center Drive — OroviIIe, California 95965
Telephone: 534-1541
APPLICATION AND PERMIT 76-
auinorize representatives or me uouniy of tsuiie to enter upon ine This permit is hereby issued under the applicable provisions of
above-mentioned propfor inspection purposes. the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
Il
e �,,� ��, % DIRECTOR OF PUBLIC WORKS
Signature of Perm!tee or Wnt
By,— .✓L.P�c � Date_
Receipt No. 1t -e'
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant Building permit-e*p4es Date ............................................
- MZ -7.}
BUILDING
Owner 6.1— C
.SQ. FT. OCC. BUILDING VALUATION
Mailing Address Pe), 904 3'9,61-11
vTelephone
*411
N,p.
Fireplace
Contractor J jU111-41414TlDA--` 6446-7—Zf /-C
Total Valuation
Mailing Address
Permit Fee
Plan Checking Fee &/or Penalty
T Iep onglo.�
Permit Fee $
$
Building Address,�Q j'� �Uv� %liir�g�yEs
PLUMBING No.1 @ FEE
PERMIT FILING FEE $2.00
04/110"P l/ �,iC%41 ('b.
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. to �J
Zoning &Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
F
W:
Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
Parking
Plans
Parcel
Declaration
Parcel Ma p
60' R/W
Im rovements
p
Lawn sprinkler system 2.00
Bldg. Plans Rec'd
Parcel Approval
Plans Approval
Permit Fee $
$
NEW ❑ ADDITION UTILITIES ❑ OTHER
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00 ` ,, 01
%/r� �/� •- � � .�` j`etl�i- A/ rjx 'f`
Main service incl. 1 meter
...
Additional meters, j4aetr 1.00
Sub -panel (12 o ess) (more than 12) i �Q
Single Family Duplex ❑ Mobil Home ❑ Others
Range, Cook -top or Oven 1.00
Water Heater or Space Heater 1.00
20 5
Light fixtures ball X20
Rec s., swit es &fix outl 5
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 -
�C.C!/f�d�/fr� ✓d�� � %�� /� 601,
Hood, Ex. Fan or F.A. Furn. Motor 1.00
Evap. cooler, gar. lisp. or D.W. 1.00
Air conditioner or heat pump
Water pump
Mobil Home Facilities 5.00
Temp. Power Pole 5.00
/ ^
License No. �eyClassification
Misc. wiring
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$ 3
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.
j(I certify that in the performance of the work for which this
ermit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
MECHANICAL No. @ FEE
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 1 1 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
TOTAL PERMIT FEE
$
auinorize representatives or me uouniy of tsuiie to enter upon ine This permit is hereby issued under the applicable provisions of
above-mentioned propfor inspection purposes. the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
Il
e �,,� ��, % DIRECTOR OF PUBLIC WORKS
Signature of Perm!tee or Wnt
By,— .✓L.P�c � Date_
Receipt No. 1t -e'
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant Building permit-e*p4es Date ............................................
- MZ -7.}
I
COUNTY OF BUTTE — YEPARTMENT OF PUBLIC W
7 County Center Drive — Oroville, California 95965
Telephone: 534-4,,,541
APPLICATION AND PERMIT
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
x � Date
Signature of Permitee or Agent
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.
DIRECT01f'bF PUBLIC WORKS
Bye° Date 62'
Ziding permit expires Date ................. 7..� .....�.
BUILDING
Owner
SQ. FT. OCC. BUILDING VALUATION
Mai I i ng Address P
Telephone No.
Fireplace
Contractor
Total Valuation
Mailing Address
Permit Fee
Plan Checking Fee &/or Penalty
Telephone No.
Permit Fee $
$ Q(
Building AddressN
PLUMBING No. @ FEE
PERMIT FILING FEE $2.00
—_—A40
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.Gas
3
Zoning &Planning
piping system 1 - 5 outlets 1.50
Each additional outlet .30
F
l n
I Fire Dept. Fire Zone
Use Permit
Building sewer 5.00
EQA
Parking
P ans
Parcel f;fcel t
Declarations P
60' R/W
Improvements
P
Lawn sprinkler system 2.00
/
Bldg. Pla d aP—rcel A prowl
Plans pproval
Permit Fee $
$
NEW ADDITION ❑ UTILITIES ❑ OTHER
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)
Single Family ❑ Duplex ❑ Mobil Home ® Others ❑
Range, Cook -top or Oven 1.00
Water Heater or Space Heater 1.00
Light fixtures Will
Receps., switches & fix outlets
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
Hood, Ex. Fan or F.A. Furn. Motor 1.00
Evap. cooler, gar. disp. or D.W. 1.00
Air conditioner or heat pump
Water pump
Mobil Home Facilities 5.00
Temp. Power Pole 5.00
License No. Classification
Misc. wiring
2<am exempt from the Contractors License Laws of the State of California.
Permit 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.
certify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
MECHANICAL No. @ FEE
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
TOTAL PERMIT FEE
$
a
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
x � Date
Signature of Permitee or Agent
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.
DIRECT01f'bF PUBLIC WORKS
Bye° Date 62'
Ziding permit expires Date ................. 7..� .....�.