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Home My WebLink About065-190-036•,Y 65-19-36 cc s " i William Eyr 8////77 W/S Holriiwoo Dr., 17''N.of-Holly Rd., ' Magalia a Permit #l809�77g,E(ut iI:44ffl) •, ELEC.� .� rti • 1; GAS SUHORT S C IQ COMPACTIO14 TEST REIR. �r i,c o r,r t-.d n f• r • . ry t - B07 20 X ;Y'*'-`065 190-036 .; �, - z ' iMISCELLANEOUS r L ` ElcctricAl \ T RE LOCATE ELEC 1 SERVICE O NE'W* 3 , 14567sHOLM�W006.'Dfxx " k `EYRE;WILLIAM & MILDRED�;? sn i ! o n ' 4 i o y I I - t. {F t j1 I r MA- BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #:(530) 538-7541 FAX#: (530) 538-2140 WEBSITE: www.buttecounty.net\dds PROJECT INFORMATION Site Address: 14567 HOLMWOOD DR Owner: Permit No: B07-2074 APN: 065-190-036 EYRE WILLIAM & MILDRED Issued Date: 10/04/2007 By KCG ' Permit type: MISCELLANEOUS P O BOX 757 Subtype: Electrical MAGALIA, CA 95954 Expiration Date: 10/03/2008 Description: RE -LOCATE ELEC SERVICE TO P (530) 873-0807 Occupancy: Zoning: RT1A ' Contractor Applicant: Square Footage: RCI A/C, ELECTRIC & HEATING RCI AJC, ELECTRIC & HEAT. Building Garage Remdl/Addn P O BOX 785 P O BOX 785 CHICO, CA 95927 CHICO, CA 95927 Other Porch/Patio Total (530) 961-3220 (530) 961-3220 FEE INFORMATION DBE Single Phase Service-Resid $58.00 LICENSED CONTRACTOR'S DECLARATION Contractor (Name) State Contractors License No. / Class / Expires RCI A/C, ELECTRIC & HEATIN( 892034 / C20 C10 / 03/31/2009 I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Contractor's Signature 10/04/2007 Date WORKERS' COMPENSATION DECLARATION I I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: ❑I 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 HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required 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: Exp. Date: (This section nee not a completed if the permit is or one hundred ollars ($100) or less. I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I shall not employ any person in any manner so as to become subject to the Workers' Compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those X- 10/04/2007 Signature 7-1 t Date WARNING: FAILURE TO SECURE WORKERS' COMP SATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for the performance of the work for which this permit is issued. (3097 civ. code) Lender's Address City State Zip ees Balance Due: $0.00 Receipt No: OWNER / BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that 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 Contractor's 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 penally of not more than five hundred dollars ($500]; Please check one of the following: ❑I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does the 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 proof that he or she did not build or improve for the purpose of sale.). ❑I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: The Contractor's License Law dows not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License Law.). ❑ I AM EXEMPT under Section B. & P.C. for this reason: IX 10/04/2007 Owner's Signature Date 1 I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal injury, including death, and property damage caused by, arising out of, or in any way connected with the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte County to enter the above mentioned property for inspection purposes. I hereby certify that I am the proarty owner or am ut rued to act on the property owner's be If. 9.OOA10/04/2007 ame of Permt e [ IG ], int I Date Owner , Contractor OR. Agent for Owner Agent for Contractor FILE COPY BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OF APPLICATION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY". CONTRACTOR OWNER INFORMATION Last Name 2 First Name Mailing Address / 2 City M +� I J e Zip Phone' .� _ C>WQ EFa E-mail State License Number CONTRACTOR Name Address O & City " (_)'ta �o State Zip Phone c�(o(— Fax u E-mail Lic. # a Q 3 Classa�'I �o APPLICANT INFORMATION ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Fax E-mail State License Number APPLICANT INFORMATION Name Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X LQa, A OdL PERMIT NO. B01 -2J1 PROJECT LOCATION API Property Address ' '4 S City J BIN # WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address DESCRIPTION OR SCOPE OF WORK: S F7, n_!:� C O ` c Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning FloodZonLType SRA Yes No Occ. nst. PERMIT NO. 1809-77P,E PERMIT EXPIRES OWNER William Eyre CONTR. owner 65-19-36 W/S Holmwood Dr., 170'N.of Holly Rd., Magalia v b ) { Temp. Power Pole Called PG&E Temp. EIec. Serv. 1 Called PG&E Temp. Gas Serv. Called PG&E JOB G -1 j FINAL ED (Date) (Signature) 9. Electrical A Is service large enoiigl. to provide adequate ampc:�rage to mobilcliome (must equal rating of mobi.lehocie with a ::;inii::um --)f 100 arnp) and other facilities on lot, i.e., water pumps, garate, cabana, etc." .Yes ✓ No B. Is ther.-� ;groper_ clearances Around panels? Yes 1// No_ C. Is power supply cord or feeder assembly properly fused? Yes _LlNc, 1 / D. Is continuity test . satisfactory as per the following procedure-.? Yes No 1. De -energize electrical wiring syste:a-of. the mobilehome at the pedestal. 2. Make sure that the power supply cord or feeder assembly conductors, including neutral conductor, have: been disconnected. 3. Switch all breakers and switches in the mobilehome to -the "on" position. 4. Connect one 1-A of a test instrument to the mobilehome grounding conductor and apply i y tl'ie c)Lhe i.c:ad t.o each mobi e,110ifLe Supply conductor, illuluuini neilLral. 5. All nor. -current, carrying metal parts of the mobilehome (aluminum siding, gas line, welter line), including fixtures and appliances, shall be tested for continuity from such equipment and the grounding conductor. 6. Upon completion of the above procedure-, the power supply cord or feeder assembly conductors shall be connected to the site service equipment. A further continuity te:;t :;hall then be made between the grounding electrode and the chassis of the rloiUpon satisfactory completion of the electrical tests, ,the lot or site service equipment may be - approved for energizing. ;_ti, 'Is job card signed by Health Dte'partmeat for' water and sanitation?' 1:.. Ii e-verythilig o3.cay, sign off card and tar, services. MOBTLEI:10.M.E DATA Manufacturer and/or Namestyle Length �L� _ _ Width / y Vehicle Serial No. b q 7J State Identification N.O. t'6 l py "...__ '1 &_ : t ional Infor-ma t i on or Cormp.ents : MOBTi.E'1110 .E' INSTALLATION INSPECTION CHECK LIST 1. Is the.. mobilehomt� locats>d 1,7-1.1_, required separation from lot lines and buildings and generally conform to plot plan? Yes Al No ?. Does the mobilehome have required clearances above ground? (Sec. 5085) Yes No 3. Are footin�,s and supports properly sized, 'spaced, and braced as �r approved plans? (Note possible variation at spring shackles.) (Sec. 5082 & 5083) Yes No 4. Is the mobilehome level.? (Sec. 5088) Yes v No� 5. If more than a single unit, are crossover connections properly installed? (Sec. 5088) Yes_ No 5, Water. A. Is fl�jxible connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes V No B. Test - Does water piping withstand working pressure or 50 lbs, air test? Yes Ll -/No C. Backflow - If coach is not State of California approved, does station have backflow device and pressure -relief valve? Yes No 7. Wastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes `JNo B. Does it have minimum z," per foot slope and is it properly supported? Yes No C. Are any leaks detected in drainage system after running 3 -gallons of water through each fixture including washing machine standpipe? Yes_ No � D. If coach is not State of California approved, does station have required trap and vent? Yes No 8. Gas Piping and Gas Vents A. Connector - Is mobilehome connected to the gas supply with an approved 3/4" minimum mobilehome connector not more than 6 ft, long? Note: All piping- is to be at least as large as the mobilehome gas line inlet without reductions other than the mobilehome connector. Yes ✓ No B. Test OK as per following procedure? Yes -"'No- 1. "'No_1. Open all appliance connector valves. 2. Shut off appliance burner and pilot valves. 3. Air test with manometer to 10"-14" water column, or test with slope gauge (minimum 6oz.-maximum 8 oz.) calibrated in tenth pound increments. Test for 10 mina without drop. 4. Connect: gas meter to mobilehome with connector, turn. on gas, test connections with soapy water. C. Are all appliance vents properly installed? Yes V No Footings structure Slab Final Patio REP ACE Footin s Footing Masonry Walls Throat Reinf. Steel Final Bond Bea FIRE SPRINKLEFk Framing Test Stucco Final Mesh MECHANICAL Scra h Heati B n Co ng nish D is I erior LathV entilation oor Closer Final MOBILEHOME UTILITIES ------------Elec. Service L -3D 7`% I Water Piping Sewer - MRS 16 E ME INSTALLATI - - - - - - - - - - - - - - Support i Water Piping11. Drainage DATE REMARKS OR CORRECTIONS a Temp. Gas Sanitation Final ECTRIC L Rough Fixtures Motors Water Htr. SubDanel ServI96 COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS x r• BUILDING INSPECTION RECORD Permanent BU,tLQING BUILDING (Cont'd) A PLUMBING SeAtack ewall TRestr So Pipingrte, For ar eta t Floor' Mat Bidg. om Finish 2n loor Fo in s. Window 3rd k0or Stem all Siding To out Slab Roof SheaAlno Water Pi I Piers Roofing Sewer Garage Fdn. Vents Fixtures Footin s Garage Vents Water Htr. Stemwa l l Insulation Heaters Slab Prov. for ph slcal Appliances Carport p handica ed Conformance of ex. Gas Piping & Test Footings structure Slab Final Patio REP ACE Footin s Footing Masonry Walls Throat Reinf. Steel Final Bond Bea FIRE SPRINKLEFk Framing Test Stucco Final Mesh MECHANICAL Scra h Heati B n Co ng nish D is I erior LathV entilation oor Closer Final MOBILEHOME UTILITIES ------------Elec. Service L -3D 7`% I Water Piping Sewer - MRS 16 E ME INSTALLATI - - - - - - - - - - - - - - Support i Water Piping11. Drainage DATE REMARKS OR CORRECTIONS a Temp. Gas Sanitation Final ECTRIC L Rough Fixtures Motors Water Htr. SubDanel ServI96 T mp. Pole oder round Permanent Final Elec. Pedestal Gas Piping Elec. Continuity Gas Piping V (NOTE: An entry must be made on this form each time you visit the job site.) COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE OROVILLE, CALIF. - 534-4541 CERTIFICATE OF OCCUPANCY This mobilehome has been installed in accordance with the of the California Administrative Code, Title 25, Chapter 51 number li22 � for the following location: i-aA 04a requirements under permit Owner r� Owner's Address Mobilehome Mfg. Model '� ' Year 3 Insignia No. G �' Serial No. It is hereby certified for occupancy at the above described location and may be occupied. Director of Public Works Date THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED I COUNTY`' OF BUTTE DEPARTMENT OF PUBLIC WORKS a 7 County Center Drive — Oroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT authorize representatives of the county of Butte to enter upon the above-mentioned property for inspection purposes. oqt Date % ;Zf . > Signature of Permititee 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. DIRECTOR 011 NJBLIC WORKS' BY/' Date Y—S - 77 B ding permit expires Date �� BUILDING Owner i SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee&/or Penalty (i Til/ i ko ON Permit Fee $ Building Address �f PLUMBING No. @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 A. P. No. 6 3 Zoning 8 Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fees 1 W.Sanitat' FireDept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration Parcel Ma P 60' R/W Improvements provements Lawn sprinkler system 2.00 Bldg. Plans Rec'd Parcelvol PI pprovol Permit Fee ,$ $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 100 AMP OROR LESS5.00 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. ADD'L 100 AMP 1.00 NEW CONS.WELING OR ADDNST t ACCLBLDGS.CCUP. &) 22.sgft NEW CONSTR. MULTI -OUTLET NON.RESI D. BRANCH CIRCUITS) 2.50ea NEW CONSTPOWER APPARATUS &) NON.RESI R. D. (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: 6 �� I�J . •On J`� u'C Ex. Occup(OUTLETS OR FIXTURES)50 @250 BAL@1 Ex. Occup. FIXED APPLNS. OR O P• OUTLETS (RESID,) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. -29g0 3 2 Classification --to 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. have placed on file with the County of Butte a certificate of F-1 'Workmen's Compensation Insurance. mI 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 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 14. 5 - 34 <ek E TOTAL PERMIT FE $ 30 "— authorize representatives of the county of Butte to enter upon the above-mentioned property for inspection purposes. oqt Date % ;Zf . > Signature of Permititee 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. DIRECTOR 011 NJBLIC WORKS' BY/' Date Y—S - 77 B ding permit expires Date �� BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA. PHONE: 534-4541 4 ' MOBILEHOME INSTALLATION SHEET 1. Owner's name: 10o) /A- L / A M 2. Installer's name: OV A LIT Y M U d tL,. Aom E St%moC 6_ 3. Is the site currently under permit? Yes. /,K/ No (If yes, furnish permit numberP•F_) OR Is the site an existing site? Yes / / No /x/ (If yes, furnish two (2) plot plans.) 4. Will the mobilehome be located at least 5 ft. away from septic tank and leach fields and clear of all setbacks and easements? Yes/ No (If no, clarify ) 5. What is the mobilehome electrical rating?,----------------------- 0 Amps 6. What is the mobilehome site service rating? --------------------- Amps 7. What is the mobilehome site circuit breaker rating? ------------- / ® Amps 8. Is there any other electric load to be served by the mobilehome site services --------------- ------------------------------------- Yes / /- No (If yes,'identify the load and size: (Load) (Amps) 3�4� 9. What is the mobilehome site gas pipe size? ---------------------- in. 10. What is the type of gas service? ----------------------------- Natural T_/ LPG /X/ 11. What is the gas pipe length from meter or tank to the mobilehome? ) (ft.) 12. What is the mobilehome gas demand? ------------------------------ a (BTU) r(T,his),nformation not required if pipe length less than 6 ft. on natural gas or less than 50 ft. on LPG.) MOBILEHOME SUPPORT DATA Mobilehome Mfr. SKY4LI E IWOOI&AF #0M AAPAI, Setup Model No. Xm r614/7S� Year r97 3 Width _(ft.) Lengthy _ (ft.) -'Ekpando Size ft.x ft. ` (Draw support details below) On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation manual and structural setup sheets (if not o,H..fi1P with the County of Butte). *If center p draw in loc re other than drawn above, , spacing, al' dimensions. Footings, (check. one) 1. Wood..either . pressure treated or fdn-. grade. 2. Concrete pad. 3. Other,: specify Supports (check one) 1. Concrete block 2. Concrete piers 3. Steel piers 4. Other, specify Typical Support Footing Size Max. Pier Spacing Max. - 0 Overhang BUTTE COUNTY BUILDING DEPARTMENT APPROVED COUNTY OF BtJT-TE' — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive. — U(ovilie, California 95965 ` Telephone: 534-4541 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X • Date L 17- Si rjefo Permitee or Agent / Receipt No. 1 ta` 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 -OAF PUBLIC WORKS By Date -3 ilding permit expires Date S, 3 -7� BUILDING Owner LIL A SQ. FT- OCC. BUILDING VALUATION Mailing Address 0 �• �T/S C /'� �L� TelephoneN Fireplace Contractor r4 e toL , Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ Building Address PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00_ -- (, Each Trap 1.50 (� , OI,Yv� i90 O • 0 Repair drainage or vent piping 1.50 Water piping 1x69' Zon Veri$cafion Only G L• Each gas water heater or vent 1.50 / //• A. P. No. tOs� �/'3 b • /CT ny Gas piping system 1 - 5 outlets �- /d) Each additional outlet .30 Fe ion Fire Dept. Fire Zone Use Permit Building sewer -w /® � EQA Parking Plans rcel Declaration Parcel Ma P 60' R/W Im rovements P Lawn sprinkler system 2.00 Id Recd a rovol Plara✓ pproval Permit Fee $ — $931 NEW ❑ ADDITION ❑ UTILITIES OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 — Main service 100 AMP ORLESS5.00 Main service EA. ADD'L too AMP 2.501,2 AA Family Duplex ❑ Mobil Home Others ❑ OVER Main service 100 AMP OR LESS 25.00 Main service EA. ADD'L too AMP 1.00 `❑ IMS �!.. Q. FT. MINIM ` OR ADDNSNEW T ( ACC. BLDGS.LING CCUP. &) 2¢ -sq ft NEW CONSTR. MULTI -OUTLET NON-RESID. ( BRANCH CIRCUITS) 12.50ea Ma MORS NEW CONST R.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)50 @25a BAL@IOQ FIXED ALNS. Ex. Occup.( OUTLETSP(RESID.)REA) 2.00 Temporary service 10.00 Mobile Home Facilities15.00— 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. ❑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 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 r TOTAL PERMIT FEE $ 3 authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X • Date L 17- Si rjefo Permitee or Agent / Receipt No. 1 ta` 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 -OAF PUBLIC WORKS By Date -3 ilding permit expires Date S, 3 -7�