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HomeMy WebLinkAbout065-300-022V i 9 foxQ65-30-22. es Tatum 14 Pineview Dr., lot 47, SDO, Magalia r - contr: Paradise M dular Concepts, Par Permit 11199-77P,2(utiL ,MH) GAS S .1' C7° SUPP T TRUCTURE REQ.— COMPACTION TEST R1Q .I/,9 A 65-30-22 -: contr: Paradise Nodular Concepts,Para. Permit #1268-'7/7MHI Issued 65-30-.22 = 1 Permit #3954-78B( new - 2 carports w/storage) � 1 s i ' o ; } COUNTY OF BUTTE D—Z-PARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE OROVILLE, CALIF. - 534-4541 CERTIFICATE OF OCCUPANCY This mobilehome has been installed in accordance with the requirements of the California Administrative Code, Title 25, Chapter 51 under permit number /24^',9--'7'1for the following location: Owner 14 Owner's Address AwIP /// A A/ Gtci. Mobilehome Mfg. - /-/-d Al16fh'��Model 41.5'/ Year Insignia No. C^ LA -Z Serial No. '"7 It is hereby certified for occupancy at the above described location and may bP occupied. Director-of-Public Ws��,/ Date r� By THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS ,RELOCATED IV4STALLATION INSPECTION CHECK LIST 1. Is the mobilehomt located wi.i.h required separation from lot lines and buildings and generally conform to plot plan? ' Y(ns ' No� '. Does the mc:)bA.ehome have required clearances above ground? (Sec.5085) Yes 1..—No 3. Are foot:ins and supports properly sized, spaced, and braced as per 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 no e than a single unit, are crossover connections properly installed? (Sec, 5088) Yes_ No 5. Water A. Is flexible connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes 1/ No B., Test - Does water piping withstand working pressure or 50 lbs, air test? Yes `—No C. Backflow - If coach is not State of California approved, does station have backflow device and pressure -relief valve? Yes_ No_ 7. [tastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes L --No B.' Does i.t have minimum ," 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 1-� D. If coach is not State of California approved, does station have required trap and vent? Yes No -e 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 R/ No B. Test OK as per following procedure? Yes 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 min, without drop. 4. Connect: gas meter to mc,bilehorle with connector, turn. on gas, test connections with soapy water. C. Are all appliance vents properly installed? YesZNo 1 9. Electrical. A Is sei-vice large enorrglk to provide adequate amperage to mobilehome. (must equal rating of mobilehome �.aith a :::iniv,um of 100 amp) and other faciliti_�ls on lot, i.e., water pumps, garac,e, cabana, ctc.? Yes L.- No B. Is them proper clearances around panels? Yes L�__No C. Is power supply cord or feeder assembly properly fused? Yes '--No_ D. Ts continuity test satisfactory as per the following procedure? Yes L�— No - 1 . o1. De -energize electrical wiring systeri of the mobilehome at the pedestal. 2. Blake 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; -.id of a test instrument to the mobilehome grounding conductor and apply t e oi;tei' lead to each niUui.�Ciwu;e Siippiy CunuuCtu'i, iliCluuiLtg neuiral. . 5. All nor. -current, carrying metal parts of the mobilehome (aluminum siding, gas line, water 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..L ;hall then be made between to he grunding electrode and the chassis of. the vi.obilehome.. Upon satisfactory completion of theelectrical tests, the lot or site service equipment may be approved for energizing. ;.0, Is job card signed by health Department for water and sanitation? 1. l.. If everything okay, sign off card and t.a_; services. MOBILEilOME DATA Manufacturer and/car Namestyle Length S- Width L� Vehicle Serial No. �Z state Identification No. � :.dei Ltional Inforimatrion or Comments: �. -1 6 �P PERMIT NO. 1199-77P,E 9 �.. PERMIT EXPIRES �,_7 OWNER James Tatum CONTR. Paradise Modular Concepts, Para. I 65-30-22 LOCATION (A.P. ) f 14 Pine View Dr., lot 47, SDO, Magalia t i t, t E i . i F { .i Temp. Power Pole Called PG&E &w. Elec. Serv. Called PG&E Te Gas Serv. Called PG&E JOB FINALED � • (Date) / fzad— (Signature) V Fixtures Framing Test Water Htr. Stucco Final Sub anel Mesh Z MECHANICAL Grd. Faidit Prot. Scratjfh Heati9b Servl Bro n Coo ng T p. Pole F ish D is tinderground In Nor Lath entllation Permanent or Closer anal inal MOBILEHOME UTILITIES ------------------ Elec. Service Elec. Pedestal Water Piping Sewer Gas Piping MOBILEHOME INSTALLAD9 - - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE REMARKS OR CORRECTIONS If (NOTE: An entry must be made on this form each time you visit the job site.) COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING ck kewall S0\1 Piping Irn Pa ets 7 Floor Mal Bldg. Rest om Finish 2n Floor Fo ins WIndo4 3rd k0or Stem all Siding To out Slab Roof Shealhina Water PI i Piers Roofing Sewer Garage Fdn. Vents Fixtures Footin s Stemwal I Garage Vents Insulation Water Htr. Heaters Slab Carport Footings Prov. for physical handicapped ' Conformance of ex. V structure V Appliances Gas Piping 8 Test Temp. Gas Slab Final Sanitation Patio FIREP ACE J Final Footings Footinq I E ECTRIC I Fixtures Framing Test Water Htr. Stucco Final Sub anel Mesh Z MECHANICAL Grd. Faidit Prot. Scratjfh Heati9b Servl Bro n Coo ng T p. Pole F ish D is tinderground In Nor Lath entllation Permanent or Closer anal inal MOBILEHOME UTILITIES ------------------ Elec. Service Elec. Pedestal Water Piping Sewer Gas Piping MOBILEHOME INSTALLAD9 - - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE REMARKS OR CORRECTIONS If (NOTE: An entry must be made on this form each time you visit the job site.) COUNTY OF BUTTE — 6EPAR+FMENT OF PUBLIC WORK 5�19-77 7 County Center Drive — Oroville, California 95965 •� ��� Telephone: 534-4541 'APPLICATION AND PERMIT , a.uuwii�c ICOcnIau VG0 UI UIc %�UUIILY UI oUttri lU CIIICI U11UI1 IIIC above -m ti ned property for ins p ion purposes. Date Signature APermitee or Agent Receipt No. / (2 C 7' O T 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 Date 3 — 2� BVIding permit expires Date ,7 Z7- BUILDING V L001 Owner SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace Contractor k.��(S� 4 t4 L. Total Valuation Mailing Address s,t�/� (� Permit Fee Plan Checking Fee&/or Penalty po,aS le hone Permit Fee $ $ Building Address PLUMBING No. @ _ FEE PERMIT FILING FEE $3.00 ,o - /H, er C, Ld jvL Each Trap 1.50 0 q 7t Repair drainage or vent piping 1.50 Water piping —U&q• t (q GI �ificaf!¢� � Each gas water heater or vent 1.50 A. P. No. (D 5- 3 Q� �• To Gas piping system 1 - 5 outlets M f/ LT Each additional outlet .30 FeeC. a t o Fire Dept. Fire Zone Use Permit Building sewerr- EQA I Parking Parcel Plans Declaration P rcel Ma P 60' R/W Im r p ovemen s Lawn sprinkler system 2.00 B I d . FEI. '., ec'd I arcel Approval Plan pproval Permit Fee $ $ 3 NEW ❑ ADDITION ❑ UTILITIES X OTHER ❑ ELECTRICAL No.1 @ FEE • PERMIT FILING FEE J$3.00 Main service 1000 AMP OR1 OR LESS5.00 Main service EA. ADD•L .100 AMP 2.50 :1 Main service OVER 600V 100 AMP OR LESS 25.00 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service EA. ADD•L 100 AMP 1.00 500 SO FT. MINIMUM NEW CONST. DWELLING OCCUP. & OR ADDNS. ( ACC. BLDGS, ) 20 sq ft NEW CONSTR( . MULTI.OUTLET NON-RESID. BRANCH CIRCUITS)2.50ea FOR MOBILES NEW CONSTR. (POWER APPARATUS & NON -RES,D• \ SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of C a Busine & Professions Code u r the name style of: Ex. Occup(OUTLETS OR FIXTURES) BA@L@29C1 Ex. OCCU FIXED APP LNS. OR P• ( FIXED AS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 G License No. O 5 7 Classification Misc. Wiring 6.25 ❑ I am exempt from the Contractors License Laws of the State of Califomia. 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 Work n'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 1,6o I TOTAL PERMIT FEE $ 3 a.uuwii�c ICOcnIau VG0 UI UIc %�UUIILY UI oUttri lU CIIICI U11UI1 IIIC above -m ti ned property for ins p ion purposes. Date Signature APermitee or Agent Receipt No. / (2 C 7' O T 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 Date 3 — 2� BVIding permit expires Date ,7 Z7- f , NOTE:—All Materials & Workmanship Shall Be in Accordasibe 'with Recognized Good Practices and of 6 quality proscribed for the Specified use in the Uniform Building, Plumbing & Mechanical Codes and the National Electrical Code. This set of plans a s MUST be ken+ on the ;-L + all times and it is unlawful +o make any chrinnes or alterations on same without written permission from i1ie Department of Public Works, County of Butte. /05••30 gyp' �?�/-`� • TM The Bldg Setback shag 6e 5 ft, from the side proper+y line and 50 ft. from the centerl*-ne of the road, permitting a maxi- mum aximum of a 2 ft.-eave overhang but entirely out of all easements. Septic system ' d- . M2 d, `*n d to be as per Butte County Health Dept. Re- quirements. - ,�•� ,,,,;,,. dao L o_ o. P-ex'w� I re wre �o c& 8s Al Oct/ 64 P� lJ �! 1� SAP, s _ 25 � S.• � � rQ�PP ���►�oPI- e t 44: L a IM' . (ti. 4;F- YA%,&. J f !mss 122r � I � DVI � UILDING DEPARTKAr Nfr" � • ;!4 r . Ea.4 4p— 3', w , 0 � P W o R, sr _ 25 � S.• � � rQ�PP ���►�oPI- e t 44: L a IM' . (ti. 4;F- YA%,&. J f !mss 122r � I � DVI � UILDING DEPARTKAr Nfr" � • ;!4 r . Ea.4 4p— ° ^ COUNTY OF'BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — Oroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT auulurlce representatives or the County of Butte to enter upon the above-mentioned property for inspection purposes. Date atur tee r 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 which fees have been paid. /7 QJRE0;T,OR OF RUBLIC WORKS -permit expires Date 73al" � BUILDING Owner SO. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace Contractor Total Valuation Mailing AddressGG Permit Fee Plan Checking Fee&/or Penalty -x� SA one PS Permit Fee Building Address It r PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 J V Repair drainage or vent piping 1.50 1pS _ 3 ®a- aZ Water piping 1.50 Each gas water heater or vent 1.50 a- A. Zoning &Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 �PNo. Fel/s I 'W. C. Sa"t+&4e9;6 FireDept. FireZone Use Permit Building sewer 5.00 EGA Parking Plans Parcel Declaration parcel Ma P 60' R/W Im rovements P Lawn sprinkler system 2.00 Bldgns Recd Parcel 415provol Plans pproval Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 r Main service 600V OR LESS 100 AMP OR LESS 5.00 ... Main service EA. ADD'L 100 AMP 2.50 Ingle Family ❑ Duplex ❑ Mobil Home Others ❑ OVER Main service 00 AMP oR LESS 25.00 Main service EA. ADD -.L 100 AMP 1.00 NEW CONST. DWELLING OCCUP. & OR ADDNS. ( ACC. BLDGS. ) 2�sgft NEW CONSTR- MULTI.OUTLET NON-RESID. BRANCH CIRCUITS) 2.50ea NEW CONSTR. POWER APPARATUS&J NON-RESID. (SINGLE OUTLET CIR, CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of Califo n'a Business & Pr fessions Co a under th name ,style Of: Y 6 Ex. Occup(OUTLETS OR FIXTURES) @@1 BALM FIXED APPLNS. OR - Ex. Occup. (RESID.) EA) 2,00 Temporary service 10.00 Mobile Home Facilities 15.00 09 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 rkmen'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.1 @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee 4 $ 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 ac auulurlce representatives or the County of Butte to enter upon the above-mentioned property for inspection purposes. Date atur tee r 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 which fees have been paid. /7 QJRE0;T,OR OF RUBLIC WORKS -permit expires Date 73al" � •'1. Owner's name: 2. 3. Installer's na BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA. PHONE: 534-4541 .MOBILEHOME INSTALLATION SHEET Is the site currently under permit?. Yes / No (If yes, furnish permit number ) Is the site an existing site? Yes / / No M (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 ) i 5. What is the mobilehome electrical rating? ----------------------- mps 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 service? ------------------------------=-------------------- Yes / / No (If yes, identify the load and size: (Load) (Amps) 9. What is the mobilehome site gas.pipe size? ---------------------- '�/ in. 10. What is the type of gas service? ----------------------------- Natural / / LPG /�- 11. What is the gas pipe length from meter or tank to the mobilehome? (ft.) 12. What -is the mobilehome gas demand? ------------------------------ .(BTU) .(This information not required if pipe length less than 6 ft. on natural gas or: -less than. 50 ft. on LPG.), MOBILEHOME SUPPORT DATA Mobilehome Mfr. Setup Model No. ©U/ Year Width (ft.) Length . So2 (ft.) Expando 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.on .file with .the County of Butte). Sin le - Footings (check: one) w/ " D I 9 Wood either pressure treated or Center Center Support A fdn. grade. Support Footing Sizes �! Locations (in.)� ,L 2. Concrete pad. 3..Other,: specify �.i n. n. �'in. Supports (check one) A4 %Concrete block [ft2. Concrete piers j in (in.)(in.) 77 3. Steel piers- 4. Other, specify (O ]� Typical Support F L�)( Footing Size ( (( in. in (In. ) (in.) (in.) Max. Pier �- Spacing t., in.) x� _..--- (��°� 4 z, sj Overhang n� *If center piers are other than drawn above, BUTTE COUNTY in locations, spacing, and dimensions. BUILDING DEPARTMENT APPROVED PERMIT NO. 3954-78B t PERMIT EXPIRES James H. Tatum .'OWNER ,CONTR. owte' LOCATION (A.P. 65-30-22 +ti 14 Pineview Dr., lot 46, Magalia t r Temp. Power Pole Called PG&E TempElea Serv. Called PG&E Temp. Gas Serv. _ Called PG&E _ JOB FINALED IRE SPRINKLERS Mc •49 Test We C I Final Su PLUMfIING ELE0TRI Scratch COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDNG BUILDING (Cont'd) Brown Setback Firewall Soil Plpin Forms Parapets 1st Floor Main Bldg. Restroom Finish 2nd Floor Footings Windows 3rd Floor StemwaII Siding – 7�' To out Slab Roof Sheathing a%8 Water Piping Piers Roofing / — ® Sewer Garage Fdn. Vents Fixtures Footings Stemwa I I N, Garage Vents Insulation Water Htr. Heaters Slab Carport -'s Footings Prov. for phsicall handica ed Conformance of ex. structure Appliances Gas Piping & Temp. Gas Slab i3 Final r 7G Sanitation Patio FIREPLACE Final Footings Footino IRE SPRINKLERS Mc •49 Test We C I Final Su PLUMfIING ELE0TRI Scratch Heatinq Service Brown Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation Permanent Door Closer Final Final MOBILEHOME UTILITIES ----------------- Elec- Service Elec. Pedestal Water Piping Sewer Gas Piping ME INSTALLATI N - - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE 5'>2 REMARKS OR CORRECTIONS J C Oil (NOTE: An entry must be made on this form each time you visit the job site.) COUNTY OF BUTTE— DEPARTMENT OF PUBLIC WO S 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. r /� X L..�.G.2 ,CN � Date / G Signature of Permitee or Agent R ceipt No. Z 7 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. DIRECTQR/6F1PUBLIC WORKS By Date %—/8-7r ��ild7inq permit expires Date BUILDING lk Owner v '13 SQ. FT. OCC, BUILDING VALUATION T 5-5v.0 0 Mailing Address Z� ie t."a cfie Q a0 f0t'3 �. G L`� Telephone No. o Contractor W Xy fr Mailing Address Fireplace Total Valuation Telephone No. Permit Fee M ` Building Address L- f//��-J Plan Checking Fee &/or Penalty Permit Fee a ��p PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 Each Trap 1,50 Ley/ Y % L wa -'Z L., Repair drainage or vent piping 1.50 A. P. No.J --30�— as Zoning & Planning Water piping 1.50 Each gas water heater or vent 1.50 Fte< IQ` -C. SJO Ion Fire Dept. Fire Zone Use Permit Gas piping system 1 - 5 outlets 1.50 EQA Parking Plans P rcel Declaration Parcel Map 60' R/W Improvements Each additional outlet .30 Building sewer 5.00 Bldg.ams Rec'd Parcel Approval Plans Approval Lawn sprinkler system 2.00 NEW ADDITION ❑ UTILITIES ❑ OTHER ❑ Permit Fee $ $ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 600v OR LESS 100 AMP OR LESS 5.00 Single Family Duplex Mobil Home 9 y ❑ P ❑ ❑ Others [A Main service EA. ADD'L too AMP 2.50 d `/Y Main service OVER 600V 25.00 100 AMP OR LESS Main service// EA. ADD'L 100 AMP 1.00 NEW CONS.DWELING OR ADDNST l ACCLBLDGS.Ccup- 20sgft 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: + NEW RESID,CONSTBRANCH CIRCUTLETITS) NON -REBID l BRANCH CIRCUITS/ 2.50ea i NEW CONSTR. POWER APPARATUS d NON -R ESID. SINGLE OUTLET CIR. Ex. Occuo(OUTLETS OR FIXTIIRES g 025 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 ELI 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. @ 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 Land Development Fee $ TOTAL PERMIT FEE $ [L 7 authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. r /� X L..�.G.2 ,CN � Date / G Signature of Permitee or Agent R ceipt No. Z 7 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. DIRECTQR/6F1PUBLIC WORKS By Date %—/8-7r ��ild7inq permit expires Date NASSIE INSURANCE SERVICES P.O. BOX L 5495 ALMOND • PARADISE, CALIFORNIA 95969 877.4968 July 13, 1978. Butte County Dept. of Public Works 7 County Center Dr. Oroville, CA 95965 Res James Tatum Dear Sir: Mr. Tatum has a Mobile Homeowner's policy #215 19-82-14'3 with North River Insurance.Company which included workman's compensation for occassional employees. Sincerely, Daniel Nassie 71 ii > o ci C�, Ci J1 lei Q , t4