HomeMy WebLinkAbout065-070-021f;'Ma I 50'1UZ1?C' 65-07-21
r.H. WORTHINGTON
IS pri. rd, 3200' W/Skyway ac-
ross from DeSabla Store, DeSable
Permit ##4059-77E (temp pow pole )
lot maintenance
)_C., 65=07=21
ler it #4460-77B,P,E,M(new single family)
CzoS-oi7o -
15
�i 0
PERMIT NO. 4460-77B,P,E,M
PERMIT EXPIRES
OWNER CARL WORTHINGTON
CONTR. owner
LOCATION (A.P. 65-07-21 )
SIS pri rd, 5/10 mi. E of 1st, inter.
2/10 mi. N of Skyway, Desabla
Temp. Pow/r Pole
Calle PG&E
TempZed
ec. Serv.
C PG&E
Tye Gas Serv.
Called PG&E
JOB Z �. ? 37
FINALED
(Date)
(Signature)
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION RECORD
BtAtl,,61NG BUILDING (Cont'd) PLUMBING
Setback (�� Firewall Soil Piping
Forms A Parapets 1st Floor
Main Bldg. Restroom Finish 2nd Floor
Footingd, Windows 1 3rd Floor
Stemwal I r Siding 3 To out
Slab Roof Sheathing I 7. "% Water Piping
Piers i"7 • Roofing Sewer
Garage Fdn. Vents Fixtures
Footings Garage Vents Water Htr.
StemwalI Insulation Heaters i
Slab Prov. for physically Appliances
handicaped
Carport Conformance of ex. Gas Piping &Test
Footings structure Temp. Gas
Slab Final -5-`, -2 fr YV Sanitation
Patio FIREPLACE Final
Footings Footing ELECTRICAL
Masonry Walls Throat �� Rough f"(r - _
Reinf. Steel Final �, Fixtures
Bond Beam '7 FIRE SPRINKLERS Motors
Framing�-- --`- 7 Test Water Htr.
Stucco Final Subpanels f' i
Mesh ME61ANICAL Grd. Fault Prot. _ �,1- • %
Scratch Heatina Service
Brown Cooling Temp. Pole
Finish Ducts Z L - Underground (�• %
Interior Lath % 3 �% Ventilation Permanent
Door Closer Final—?-3"i Final
MOBILEHOME UTILITIES ----------------•- Elec. Service Elec" Pedestal
Water Piping Sewer Gas Piping
MOBILEWOME INSTALLATION - - - - - - - - - - - - - - Support Elec. Continuity
Water Piping Drainage Gas Piping
DATE REMARKS OR CORRECTIONS
fs
(NOTE: An entry must be made on this form each time you vislt the job site.)
R
Permit: 4059-77E
'WORTHINGTON, C.H. .
SIS pr& rd, 3200' W/Skyway,
across from Desabla Store,
(temp power pole lot maintenance)
AP: 65-07-21
/7
CA,U P68 C,
COUNTY OF BUTTE — DEPARTMENT OF PUB4.IC WORKS
7 County Center Drive — Urovi Ile, California 95965
-Telephone: 534-4541
APPLICATION AND PERMIT
V
icNicocniau vVo v� UIV liUUIILY UI DUIIC lv elllel UPUII me
above-mentioned property for inspection purposes.
X
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
Building permit expires Date
NN
Date
BUILDING
Owner • ,° �"+'� '
SQ. FT: -OCC. BUILDING VALUATION
Mailing Address
Telephone No.
Fireplace
Contractor _
Total Valuation
Mailing Address
Permit Fee
Plan Checking Fee &/or Penalty
Telephone No.
Permit Fee
Building Address i. {
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00
/T
Each Trap 1.50
Repair drainage or vent piping 1.50
r.
Water piping 1.50
Each gas water heater or vent 1.50
-
A. P. No.
Zoning & Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
Fees
W.C.
Sanitation
Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
Parkin
Plans
Declaration
IBldg.
Parcel Map
60' R/W
Improvements
Lawn sprinkler system 2.00
Plans Recd I
Parcel Approval
Plans Approval
Permit Fee $
$
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
00V OR L
Main service 100 AMP ORSLESS 5.00
Main service EA. AOD-L 100 AMP 2.50
Single Family ❑ Duplex ❑ Mobil Home ❑ Others ❑
Main service OVER 600V
100 AMP OR LESS 25.00
Main service EA. ADD'L 100 AMP 1.00
'
NEW CONST. DWELING
OR ADDNS. ( ACCLBLDGS.CCUP. &) 20sgft
NEW CONSTR. MULTI -OUTLET
(
NON-RESID. BRANCH CIRCUITS) 12.50ea
NEW CONSTP- POWER APPARATUS &
NON-RESID. (SINGLE OUTLET CIR.
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
�'• `''
Ex. Occup(OUTLETS OR FIXTURES) -BA L�
Ex. OCCU FIXED APP LNS. OR
P•(OUTLETS (RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
WORKMEN'S COMPENSATION INSURANCE
I am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
I certify that in the performance of the work for which this
permit is issued I shall not em
p Io an employ y person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
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
MECHANICAL No. @ FEE
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
TOTAL PERMIT FEE
$
icNicocniau vVo v� UIV liUUIILY UI DUIIC lv elllel UPUII me
above-mentioned property for inspection purposes.
X
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
Building permit expires Date
NN
Date
THIS is TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE CURRENT ENERGY REGULATIONS,
CALIFORNIA ADMINISTRATIVE CODE, TITLE 2S, STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
Street o um er Tract No.
EXTERIOR MALLS glass
Manufacturer `J — m Thickness/Type zItf i b e r R Value 1 1
CEILINGS
Batts, Manufacturer Thickness R Value
Blown: Manufacturer Allier 1 Mg r d Thickness S No. Bags3 1 wt./Bag 4 0
SQ. Ft. Covered 1 5 5 8 R value 19
FLOORS D
Manufacturer Thickness/Type R Value
SLAB ON GRADE
Manufacturer Thickness/Type R Value
r
Width of Insulation inches
FOUNDATION MALLS
Manufacturer A Thick ess/ ype R Value y
GENERAL CONTRACTOR LICENSE NUMBER
By TITL DATE
INSULATID ONTRACT I -C HO L SON I N SU LAT I ON LICENSE NUMBER 212461
BV IX -->& TITLE Owner DATE 1/78
/aq/
N
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive -- Uroville, California 95965
Tetephone: 534-4541
APPLICATION AND PERMIT
40, -57? -77
�r.���n u ves the County vI Butte to enter upon the
above-mentioned property'jffor inspection purposes.
X C��r.� %1 (Wl ate
Signature
%of eermiteeor Agent
`
Receipt No. r 0 / nt
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.
DIEC4"—TOR OF PUBLIC WORKS
By Date
- T // 9 -7-1
permit expires Date �' / 0 /7 tr
BUILDING
Owner PLT N -A -'7-0 nc
SQ. FT. OCC. BUILDING VALUATION
Mailing Address cc (�o t, 'T— L�
Telephone o.
— S^�
Fireplace
Contractor
Total Valuation
Mailing Address
Permit Fee
Plan Checking Fee&/or Penalty
Telephone No.
Permit Fee
Building Address12 - � Et () U IL
w
PLUMBING No. @ FEE
PERMIT FILING FEE $3.00
1h1 s!� ii�e r4 C �� S f DC f A 15 E..
Each Trap 1.50
Repair drainage or vent piping 1.50
Water piping 1.50
/f c- 14'
Each gas water heater or vent 1.50
A. P. No. S^ L 2 (
Zoning &Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
F
W.C.
9ertitatiea,
Fire Dept.
I Fire Zone
Use Permit
Building sewer 5.00
EQA
Parkin
PlansBI
Declaration
Parcel Map
60' R/W
Improvements
Lawn sprinkler system 2.00
ans ec
Parcel Approval
Plans Approval
Permit Fee $
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER
ELECTRICAL No.1 @ FEE_
PERMIT FILING FEE $3.00 `
Main service 600V OR LESS
100 AMP OR LESS 5.00
Main service EA. ADD'L 100 AMP 2,50
Single Family ❑ Duplex E)'\1 Mobil Home ❑ Others
Main service OVER 600V
100 AMP OR LESS 25.00
Main service EA. ADD'L 100 AMP 1,00
�' r7 -til+ �/� C
!-L r222 A J iT
NEW CONST. DWELLING OC CUP,&
OR ADDNS. ACC. BLDGS. 120Sq ft
NEW CONSTR. MULTI -OUTLET
NON -RES ID. (BRANCH CIRCUITS) 2.50ea
NEW CONSTPOWER APPARATUS &)
R.
NON-RESID. (SINGLE OUTLET CIR.
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
IUJI -. .—
Ex. Occup(OUTLETS OR FIXTURES)@�
L@101
Ex. Occu FIXED APPLNS, OR
P•(OUTLETS (RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No.Classification
Misc. Wiring 6.25
I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
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.
Elhave 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 em
P Io an employ y 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 $
$
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
authnrie ..♦ +t...... ..I
TOTAL PERMIT FEE
$ J--
�r.���n u ves the County vI Butte to enter upon the
above-mentioned property'jffor inspection purposes.
X C��r.� %1 (Wl ate
Signature
%of eermiteeor Agent
`
Receipt No. r 0 / nt
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.
DIEC4"—TOR OF PUBLIC WORKS
By Date
- T // 9 -7-1
permit expires Date �' / 0 /7 tr
RESIDENTIAL PLAN CHECKING GUIDE
(S.F., DUPLEX,• & MISC.. ONLY)
OWNER �� wmal"t) C�T� Bldg. Permit #
A.P. # �5� — '� —21
A. GE&NERAL
Zoning requirements (sideyards and parking) . �1f1Sts `6Utj'
Valuation.
Signature by R.C.E. or Architect (if required).
B. PLOT PLAN
Complete parcel size and dimensions.
Setbackq, sideyards, easements, etc.
Other buildings or structures.
Grading, fills, drainage.
C. FLOOR PLAN
Complete to scale plan with dimensions.
Required windows for light and ventilation (Sec. 1405).
Required windows for second exit (Sec. 1404).
,�✓. Allowable glazing for energy requirements (20% max. per State law).
/ Human impact glass (Sec. 5406).
Required room sizes, ceiling heights (Sec. 1407).
/ G.F.C.I.'s in baths and exterior outlets (Sec. 210-8).
Light fixtures, switches, receptacles, and exterior receptacles for maintenance of
mechanical equipment.
Locations of water heater, heating & cooling equipment, other electrical or gas
/ equipment, and plumbing fixtures.
Garage firewall, door size, and closer (Sec. 503(d)(4)).
1 1 - 3'0" exterior exit door (Sec. 3303d).
Fireplace location.
Smoke detectors (Sec. 1413).
D. STRUCTURAL DETAILS
Y. Foundation plan complete enough to construct building.
FlooN construction details complete enough to construct building.
Elevations and wall construction details complete enough to construct building.
Roof construction details complete enough to construct building.
Fireplace construction details and calcs if over one-story in height.
Sufficient data and details to satisfy energy insulation requirements (State law).
E. MISCELLANEOUS ITEMS TO LOOK OUT FOR
CCX plywood on exposed locations and overhangs.'
Stairway details (Sec. 3305).
Guardrail details (Sec. 1716).
��✓ Brick or stone veneer (Chapter 30).
Exterior plaster — weep screeds (Sec. 4706 & 4708).
Proper roof pitch for roof covering (Chapter 32).
Rafter ties or bearing ridge beam.
Garage door or porch header sizes.
Adequate bracing.
5' O. Living area over garage - complete 1 -hour separation required including supporting
walls and posts, etc. %
Two (2) exits on three-story dwellings (Sec. 3302).
H
February 10,1978
� to
count
LAND .OF NATURAL WEALTH AND BEAUTY
PLANNING COMMISSION
LAWRENCE J. LAWSON
DIRECTOR OF PLANNING
7 COUNTY CENTER DRIVE — OROVILLE, CALIFORNIA 95965
Telephone: 534-4601
CERTIFIED -RETURN RECEIPT
Mr. Carl Ho Worthington
Star Route, DeSabla
Magalia, CA 95954
Re: Use Permit No. 78-15, AP 65-07-21
Dear Mr. Worthington:
Enclosed is your validated Use Permit No. 7815 to allow an
apartment on property zoned "TM -5" (Timber Mountain, 5 -acre
parcels) located on the south side of a private road approxi -
..mately 1/2 mile east of its intersection with Skyway at the
DeSabla Store, north of Paradise*, California.
Should you have any questions, regarding this matter, please
contact this office.
Sincerely,
Lawrence J. Lawson
Director of Planning
/db
enclosure
cc: —bept. of Public Works (2)
Health Department
Butte County Fire Dept.
K any use for which a use p@Fn;if. has WEi'a �r_,nf d. is Unless Aerwise provided for in a condition to a use
•� n& established within one year; -¢f the date of receipt permit, all conditions must be completed by the
e permit by fhe pern4 mittee, the pershal9 become USE PERMIT permittee within 12 months of the delivery of the permit
nu and void and' reapplication shall be recibired tb to the permittee.
establish the use previously cgranted.
BUTTE COUNTY PLANNING COMMISSION DATE (Do not issue before appeal time has lapsed
• V rF•
' • PERMIT NO.
OUK
ASSESSOR'S PARCEL NO.
Pursuant to the provisions of the Zoning Ordinance of the County of Butte and the special
conditions set forth below:
NAME is hereby granted a Use Permit
in accordance with application filed:
DATE
Failure to comply with the conditions specified herein as the basis for approval of appli-
cation and issuance of Permit, constitutes cause for the Planning Commisston to revoke
said permit in accordance with the procedures set forth in the Butte County Zoning Enabl-
ling Ordinance.
SPECIAL CONDITIONS:
+ ;k
I hereby declare under penalty of perjury that I have read the foregoing conditions,
that they are in fact the conditions which were imposed upon the granting of this use
permit, and that I agree to abide fully by said conditions.
Dated:
Applicant
NOTE: Issuance of this Use Permit does not waive requirement of obtaining Building
and Health Department permits before starting construction, nor does it waive
any other requirements.
Chairman of Planning Commission
TO: Del Siemsen,
%rre
Inter-Dnp®rt :a ' �t emornndurti
�cOUNS%
Deputy County Counsel
FROM: Jim Lawson, Planning Director
r o�
SUBJECT: Carl H. Worthington - Use Permit to allow a duplex - TM -5 zone.
Board of Zoning Adjustment Agenda - October 26, 1977
DATE: November 7,. 1977
As you recall, in our conversation last weekI related to
you that Mr. Worthington had applied for a use permit for
a duplex on October 26, 1977, and that the request fora
duplex was denied by the Board of Zoning Adjustment.,
Unfortunately, lir. Worthington left the meeting of the
Board of Zoning Adjustment with the clear impression that
while the duplex had been denied, it was denied -on the basis
that the Board of Zoning Adjustment felt that a du.plex
application was not necessary - that, in fact, he could
proceed with his construction as originally intended..
In fac.t,.the newspaper account of the proceeding, which I
verified from the tape, shows that Mr. Appleman, a member of
the Board of Zoning Adjustment, stated: "If no one knows,
then it doesn't matter."
Referring to Mr. Worthington's stated intent to install a
second kitchen unit, a second set of sanitary facilities
for an independent living for a relative - Mr. Worthington
is apparently basing his position on the definition of "family"
which states a family is an individual or two or more persons
related by blood or marriage, or a group of not more than six
persons, excluding servants who need -not be related by blood
or marriage living together in a dwelling unit. Mr. Worthington
feels that since the people who will be occupying the independent
living unit that he is constructing on the upper floor of -the
building are members of his family, that the independent nature
of their quarters does not constitute the construction of a
multiple family unit.
You related to me that the facts of the case were that
Mr. Worthington did not have a permit for a multiple family
dwelling unit, i.e., duplex, etc., and that therefore the
building permit should be issued for a single family dwelling.
Mr. Worthington has, in fact, received a single family dwelling
permit. Accordingly, you advised me that Mr. Worthington
should work with the Building Department in determining whether
his plan fits the description of a single family dwelling in
the judgement of the Building Department.
//_ f - ?7 'T: i -s
j �+ �4 L1 :. i-� �t J./)r� �! c -4- Z.- e.p..,.,.,�C.-�t_ / V • `� V ✓V
Memo to: Del Siemsen
November 7, 1977 Page 2
You also advised that if there was a doubt. as to the-inter-
pretation
he interpretation of Mr. Worthington's situation, you would. be
willing to work with the Building Department to determine,
whether the plans submitted by an individual applicant would
fulfill the requirement of a single• family dwelling, but
that it would be difficult legally to prohibit the issu-ance
of a permit f.or a dwelling with . two, kitchen facilities. It
is my understanding that the Building Department will: be
asking for your. interpretation in th,i.s matter..
Mr. Worthington has repeatedly called this office and I have
had some difficulty in getting through to: him that. th-e issue
of interpretation is between the Bui.lding Department a-nd- your
office.. As far as this office is concerned., the plan clearly
shows that two 1 iving units 'are beinG .constructed within .a
single building, with each.unit ca.pable.of functioning
independently.
I would call your attention to the definition of a. multiple
family dwelling, page 3, definitions 24-21'.11. "A building
or portion thereof used and designated as a residence for two
or more families living independently of each other, including
apartment houses, duplexes, apartment -hotels and flats, but
not including automobile or trailer cou.rts..".
While Mr. Worthington's situation fits within the definition
of a family, it is obvious that in the future, once the second
unit has been constructed with independent ingress, egress,
and self-contained in the sense that it has its own sanitary
and cooking facilities, that the second unit could and probably
will become a rental unit for a subsequent buyer. It is my
understanding that Por. Worthington has not received a: permit
for the second kitchen facility from the Building. Department
Although this -matter is out of this department's jurisdiction,
I would request. that you discuss this problem with the
Building Department to resolve this matter, since M r.. Worth-
ington will be pressing for an answer.
/ma
cc: Jim Glanders Building Dept.
J I 'A - "
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive' OroviIfe, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
autnorize representatives of the County of Butte to enter upon the
above-mentioned property for i spection purposes.
XSignature of Perm tee or Agent
Receipt No. 1 l) (NQS, !04J
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.
�j�DIREC�OFLIC WORKS
By �`Date Z
Building permit expires Date
BUILDING
OwnerCa —to" �, V_-�
SO. FT. OCC. BUILDING VALUATION
Mailing Address6
I
lephone No
1
Fireplace 1 Q -b
Contractor
Total Valuation
Mai I i ng Address
Permit Fee
Plan Checking Fee &/or Penalty
Telephone No.
Permit Fee
Building AddressPLUMBING
1v
No.1 @ FEE
PERMIT FILING FEE $3.00
i6D ON tEach
Trap 1.50 f d
SJ_Repair
drainage or vent piping 1.50
Water piping 1.50
S Zoning Verification Only.
Each gas water heater or vent 1.50 Sn
�,�
A. P. No. 11 0 _
`��yl c.
Zani n
Gas piping system 1 - 5 outlets 1.50
additional outlet .30
F
W S i ion
Fire Dept.
Fire Zone
Building sewer 5.00
EQA
Parking arcel
Plans Declaration
Pri el a P
60' R/W Im rovements
P
Lawn sprinkler system 2.00
Bldg. PIa ec'dParcel
Approval
Plan App10'roval
Permit Fee $ ��
NEW ADDITION ❑ UTILITIES ❑ OTHER ❑
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00 0-0
Main service 100V OR 0 AMP OR 0LESS 5.00
Main service EA. ADD'L 100 AMP 2.50
Single Family Duplex ❑ Mobil Home ❑ Others ❑
Main service OVER 600V
100 AMP OR LESS 25.00
Main service EA. ADO'L 100 AMP 1.00
OR ADDNS. (D CUP. &) 2¢sgft
,
NEW CONSTR. (MULTI -OUTLET
NON-RESID. ( BRANCH CIRCUITS) 2.50ea
NEW CONSTR. POWER APPARATUS &)
NON.RESID. (SINGLE OUTLET CIR.
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
Ex. Occup(OUTLETS OR FIXTURES)25G
BAL@1
FIXED APPLNS. OR
Ex. Occup. OUTLETS (REST D.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
I am exempt from the Contractors License Laws of the State of California.
Permit Fee
WORKMEN'S COMPENSATION INSURANCE
I am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑ I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
I certify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
MECHANICAL No. @ FEEPERMIT
FILING FEE $3.00
HeatingAA, 1110 r
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 EE
autnorize representatives of the County of Butte to enter upon the
above-mentioned property for i spection purposes.
XSignature of Perm tee or Agent
Receipt No. 1 l) (NQS, !04J
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.
�j�DIREC�OFLIC WORKS
By �`Date Z
Building permit expires Date