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Home My WebLink About065-190-038065-r19-0=038` •3445 ` 91.- ` HARL*AN; SONDRA,:: �- n1 CONTR FOX PETE I 14540 WOOD.DR, MAGALIA DECK/SF' IF RESIDENTIAL i 065-19-0-038 91-3445 HARLAN, SONDRA CONTR: FOX, PETE I 14540 WOOD DR, MAGALIA DECK/SF li k t1� Y. t ` 4 ti r JOB FINALE Signature y.. J=OK O = Not OK Not = Not Readyable M O BTL E `H O M E S Date ' MOBILE HOME UTILITIES (Plans) OK except #'s 9. Siding; Nailing -Veneer -Stucco -Mesh 1. Zoning Requirements -Setbacks -Easements 10. Roof; Shthg-Roofing 2. Soils; Special MH Support Sketch 11. Ext.; Steps -Doors- andings 3. Sewer; Location -Test -Fall -C/O Concrete 4. Water; Location -Test -Easement Needed (Sketch) Ai Card B-1 Date Card B-1 5. Electricity; Location-Clearences-Grnd-/ /Amp -Concrete Card B-1 Date Card B-1 6. Gas; Location -Test -Wrap: / /"L" ft. / /"Nat. or/ /" L" ft./ /"LPG POOLS (Plans) OK except #'s 7. Well Clearance & Disconnect 1. Setbacks -Easements 8. Utility Clearance 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Date MOBILE HOME INSTALLATION (Plans) OK except #'s 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 1. Zoning Requirements -Setbacks Easements 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. 2. Footings; Size -Spacing -Marriage Line Boxes-Enclosures-Panelboards-Ins. to Main in Conduit 3. Gas; MH Test -Demand -Valve -Connector 9. Health Department Approval 4. Electricity; MH Test -Crossovers -Breakers -Clearances 10. Plumb.; Cir. Test -Water Supply Test 5. Drain; MH Test -Fall -Flex Connector 6. Water; MH Test -Regulator -Connector 7. Water and Sewer Connected -C/O to Grad= -HD Approval 8. Gas and Electricity Tagged Card B-1 Date Card B-1 9. Exits; Insp.-Sketch Card B-1 Date Card B-1 10. Cert. of Occupancy Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 �r 99 MISCELLAN"C'US Date DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except #'s 1. Zoning Requirements -Setbacks -Easements ootings; Soils -Size -Depth -Spacing -Connectors -Steel 3:' ecks; Griders and/or Joists -Decking -Bracing -Stairs -Rails Wood Awn.; Posts- Beam s-Rftrs.-Connectors Shthg.-Rfg.-Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors 7. Electric 8. Frmg; Sils-Anchors-Studs-Rftrs-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors- andings Date Ai 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 -Structure Stability 3. Pool Structure; Steel -Connections -Thickness Dead Men -Lining 4. Elec.; Receptacles and Lighting, Distances-GFI 5. Elec.; Pool Lighting; 15 volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -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 Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 'J OK O = Not OK = Not Readyable RESIDENTIAL,(; Date UNDERFLOOR (Plans) OK except #'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 #'s 16. Water Htr.: Vent -Access -Combustion Air -Baffle ----------- -- - -------------------------- 17. Water Pipe: Test & Anchor -Nail Protection -- 18. 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. Elec,. Receptacles Spacing -Lights & Switches at Doors --- --------------------------------------------------------------------- 24. Size Boxes & No. of Conductors -Stapled 25. Romex Installed Close to Edge of Studs & C.J. --------------------------------------------------------------- 26. Equip. Ground made up w/Meth. Fastners-Bond Gas & Water ------ ----------------------------------------------------------------- 27. 2 Appliance Circuts in Kitchen & Conductor Size/GFI -- --------------------------------'------------------------- 28. Subfeed Wire Sizer ga. Cu or AI-A.C. Wire Size ! ! ga. Cu or At - --------------------- ---------- ------------- --- - --- 29. Range Circ. ! ga. Cu or AI -Oven Circ. / / ga. Cu or Al. Insulated Neutral 0- Yes No ----------- ------------ ------------------------- 30. Service -Riser Conductors & Ground -Main Disconnect ------------- - - - ---- -------------------------------- Equip. ------------ Equip Clea - --races Panels-Motors-Mech. Equip. --------- -----n-------------------------------------------------- 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 #'s 34._.A. -C.- Ducts Insulation & Support --------------------------------------------------------------- 35. Vent Fan Exhaust above insulation --------- ------ --------------------------------------------- ------------- 36 ---------------------- 36 Condensate Drain & 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 #'s 39. Sils. Proper Material & Anchors ------- ---------- -------------------------------------------- ------ ------------ 40. Walls Stud -s -Nailing. -- Spacing -&-Bracing-Plates-Sound ----------------------------------------------- ---- 41. Bearing Walls over Girders & Floor Nailing - --------------------------------------- -------------------------- 42. Draft Stop in Walls (rat proof) ------------------------------------------------------------- ------------- 43.- - Fire -Stops: Furred Ceilings -Stairs -Chases -Tub ------ --- ---------------------------------------------- 44. Headers & Beam -Size & Bearing jingle & Duplex) 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: Nail gni 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 #'s 61. Ext. Steps -Door & Sidelignt Protection -Landings 62. Smoke Detector 63. Furnace: Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor -Cutts -Meth. Protection 64. Bedroom Exiting -------------------- 65.-G.-F.I.& Bath Fixtures & Tub Access -Spa 66. Elec. Trim & Subpanel: Breaker Sizes & Labels ----------------- ------------ 67. Stairs -& -Rails _ 68. Fireplace or Stove Clearances -Hearth ------------ ------------------------------ 69. Elec. Outlets at Wood Panel; Int. & Ext. ------...-------------------------- --- 70. Kit.Fixt. & Appliance: Grnd.-Air Gap -Cooking Clearance -- - ----------------- 7 1. -------------71. Elec. Outlets & Receptacles at Kit. Counter ----------- 72. Garage -Fire -Door: Swing -Landing -Closer ------------------------- - 73--A.C. Duct in Garage -Damper ------- ------------------------------- - 74. Wtr. 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- Rails & Deck -Const Caps ----------------------- - 79. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth - -------- Clearance Looked -under Floor O Yes --- - ------------------------------- - 80. Following instld.: Drive ❑ Yes ❑ No: Walks 0 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. Water Well: Disconnect, Electrical, Plumbing 85. Exterior Elec. Trim; G.F.I. Receptacle -Underground ----------------------------- - -- a6. Ventilation Throughout House -- -------------------------- ------------------------- 87. Glass Protection -- .------------- -------------------------------- 88. Corrections from Previous Inspections - ------------ ------- ------------------- ------- ------- 89. Gas -Test -Meters -Tagged; Gas -Electric ------------------------------- ------ ----- -- 90. Water & Sewer Connected-C!O to Grade -HD Approval 91. Energy Compliance Certificate -Other Certificates ------...------------------------------------------ --- Date Card B-1 Date Card B-1 ------------------------------------------- - -- Date Card B-1 Date Card B-1 Date Card B-1 Date Card B-1 Comments at Final: COUNTY OF BUTTE h t' DEPARTMENT OF PUBLIC WORKS ` 196 Memorial Way, Chico — Phone: 891-2751, 7 County Center Drive, Orovi Ile — Phone: 538-7541' 747 Elliott Road, Paradise — Phone: 872-6307 ' CORRECTION NOTICE ri Akz.LAJ JWNER PERMI NO. w A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office 0d% LLJAO- , �AT_ -761 J Date / Inspector f "fTT+•y i}x }i Fy '•.Y Ff y�ss •y�a n J Date / Inspector 65 So 9COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - OrovMe, Cellfornia 95965 - Telephone: 916/538.7541 APPLICATION AND PERMIT PERMIT NO. 3445-91 .n ASSESSOR'PARCEL NUMBER 19-38 ZONING RTI A BUILDING PERMIT OWNER dra Harlan TELEPHONE 873-3794224 S0. FT. OCC.1 BUILDING VALUATON coy 2 OWNER'S MAILING ADDRESS 14540 Wood Dr Ma alia 95954 CONTRACTOR'S NAME Pete Fox TELEPHONE 873-0378 CONTRACTOR'S MAILING ADDRESS 14201 Racine Cr Ma alfa 95954 Fireplace CONSTRUCTION LENDER UNKNOWN _ Total Valuation Is LENDER'S MAILING ADDRESS Filing Fee $ 15,00 Permit Fee $ 45.00 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee ,$' . L ..JJ 2250 Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 14540 Wand Dr, MnRnlin Permit fee $ 2 .50 PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SFRX Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W 1 15.00 TYPE OF WORK New ❑ Addition k Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe work: coy deck Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 200AORLESS 18.50 Main service 200ATO1000A' 37.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professio s ee and�ny license is in full rce and effect. License .JO. Classification Fl 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason DWELLING OCCUP.ek\ NEW OR ADDNS. CONST. ( / ACC. aLOGS. I 3.6asq.ft. NEW CON5TR ULT'.OUTLET NF BRANCH CIRC ITS @ 5.00 POWER APPARATUS .&) (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20 76 FIXED APLNS. Ex. Occup. OUTLETS P(RESID IKEA.) I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 9 15.00 _E I Permit Fee $ — WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ❑ I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling g Hood 6.50 Ventilation penult Fee $ Contractor 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. I also agree to save, indemnify and keep harmless the County of Butte against all li ies, judgments, cots, and expenses which may in any way accrue t a n id Cunt in� uence of the granting of this -permit. Date . 9 PP ❑ Contractor Agent An ion oofsHA structures tis over 39uired stoiriessoineha excavations over 5' "deep and demolition or construct- Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE I TOTAL EE 82.50 HAz DFEES IMP FL o c ve- PD H Is E This permit is hereby issued under the sions of the Butte County Code and/or work indicated above for which fees Eal CTO OF PUBLIC By PER EXPIRES Date applicable provi- resolutions to do have been aid. WORKS p Date/9- F /o _ — 4 Receipt No. 4 h WNITC-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT , to OWNER COUNTY F BUTTE - DEPARTrJfFmT OF PUBLIC WORKS - BUILDING J T E T R R E R LS F DIVISION �/yV7 COUN Y C N E D IV - O OVIL EE CzLI ORNIA 95965 - TELEPHONE: 916/538-7541 PERMIT APPLICATION DATA SHEET Permit No. PAA y� A. P. No. Proposed Building Use 4:.2deAe6l 0?61t �9 Building Inspector Cs"'/ Date F12 2 9z.,� At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED 1. All items have been'submitted..................................... .2. Plot plans in duplicate/triplicate, signed by preparer of plans........ 3. Complete plans in duplicate/triplicate, signed by preparer. of plans . . 4. Complete engineered plans and calcs, with wet signature on plans .. 5. Hazardous Material Form :....................................... . 6. Energy Design Compliance and supporting documentation ......... 7. Statement of Intent for Non -Heated and AC Buildings ..... • ..... • . . 8. Engineered truss details and layout in duplicate (required„prior to plan check) 9. Mobilehome installation data including manufacturer's installation instructions....... .............................................. 10. Fees of $ 11. Chico Urban Area fees paid ....................................... 12.'Park fees paid ...................................................: School District fees paid .............. 4. anitation approval from fl? RI9/0 ISS Health Department 7 15. City of Chico plumbing permit ..................................... 16. Plot plan and business license approval from City of (see City for other requirements) 17. Planning approval for (A) Use: (B) Parking: 18. Improvements may be required. Contact Land Development Section DPW ` 19. Driveway permit (construction approval required prior to occupancy) t. 20. Pre -Inspection for required ... Pre-Inspec. request to Building Inspector 1 (Date) 21. Contractor's license information (No., Name Style, Classifications ... 22. Certificate of Workmans Compensation Insurance .................. 23. Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) .. ' 24. Recorded copy of Agricultural Acknowledgment Statement ......... --� 25. Letter of ,signature authorization ..... r J •1'7 � L.�% JC �� i% g�r� .� IJiO,/.� G PCZ.../ ... 27 �) When you issue the permit, process as follows: Mail to owner: ail to contractor. Telephone and hold for pickup at office. Deliver w/inspector. Other ' ) Applicant Date I - 4q �7/ Copy of Hdz-Mat form sent Health Dept. FireL6ept. 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 itemsrNo. 2. Additional items required: Contractor, designer, owner, was advised of above required data by_phone_rnail—counter by .date Contractor, designer, owner, was advised of above required data by—phone—Mall o' ter by date Plans checked by Date Plans approved by Date _ Sets of plans on hold in s File cabinet AP folder Copy—DPW cool pRwE �,: IF,-lvironrne ntal 1-lealth F-'"rifi'%ONMENTAL HEALTH .SEP- 2 5 1gg� W010'w, Cebmias � s V/ Int �✓; Jl� 3 pl i! L, N' G . " a i Vjf\'< lo. -19-39 V/ Int �✓; Jl� 3 pl TOS Buildina Department 47. FROM: Environmental Health E - SUBJECT: Sanitation Clearance a6A Va/V-N Own r Location AP# Plan Approved for: Sewaqe Disposal Water Supply Hold final for: Water Supply Final clearance O.K. for: Water Supply Clb arance for bedroom mobile home. Other NLa-A61AQL --L�;QAM) Sanitari n Date COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 3 7 County Center Drive - Orovllle, California 95965 - Telephone: 916.538-7541 APPLICATION AND PERMIT ASSESSOR PARC L NUMB R .. a 9 - 9 • � YONIN t /,e BUILDING PERMIT OWNER c /n� �/ V Q/VM� 6RA Hca /A TELEPHONE 273-379 SO. FT. OCC. BUILDING VALUATION -Lz 1 M I IN OWNER'SG ADDRESS l'-1 O w DOD 194 A441 -)A C4S1 CONTRAS ORSNAME f %E FlyK TELEPHONE e73 0-!i CONTR-Zo I'S MAIL ,CD,ADDRESS /l/ Y�V a, M,4411, Id 64/p��- /`/F9 Fireplace CONSTRUCTION LENDER UNKNOWN Q Total Valuation $ �/ -2— Filing Fee $ 15.00 LENDER'S MAILING ADDRESS LENDER'S Permit Fee $ 25-. ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ 2 Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ 92—s-'01 PLUMBING PERMIT Filing Fee 15.00 y0 %j�00D /�2 Each Trap 5.00 AAA 4(G/4 0A Cre Solar or heat pump water heater 20.00 LOT NO. `7 6I SU BDI VISIONt�NAME Ir -,A n VLA � PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W @ 15.00 TYPE OF WORK Ne Addition Remodel❑ Utilities [I Installation❑ Other ❑ Describe work: _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 600v OR LESS 18.50 200A OR LESS _ Main service 200A TO 1000AI 37.50 CONTRACTORS LICENSE LAW I decla under penalty of perjury (check one): I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professio C de and my license is in full force and effect. License -�O. Classification ❑ 1, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST.OR ADONS. l // ACC. SLOGS. DWELLING OCCUP.E I 3.64sq.ft. NEW CONSTR MU TI.ouTLET NON-RESID BRANCH CIRC ITS @ 5.00 POWER APPARATUS 6 (SINGLE OUTLET CIR. Ex. Occu 20 76d Occup(OUTLETS OR FIXTURES 0464 FIXED APLNS. Ex. OCCUp- OUTLETS PIRESID,IREA.� I .3.00 Temporary service 15.00 Mobile Home Facilities 15.00Misc. Wiring g 15.00 Permit Fee $ Contractor — WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. �I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ❑ I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revDked. MECHANICAL PERMIT FiIingFee 15.00 Heating Cooling g LHood 6.50 Ventilation permit Fee $ Contractor 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 or Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue said C unty in nse uence of the granting of this permit. �7� Date Y `ojU � e of A Iicant - owner pp ❑ Controcf Agent ❑ pnSVHApermit is required for excavations over 5'0" deep and demolition or construct- ructures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ DCC CONST TYPE i TOTAL FEE $ �Z .• S fl HAz DFEES IMP FLOOD cDF PARCEL PD HD IssuE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By Date PERMIT EXPIRES Date Receipt No. 2q?q(.3 WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT