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Home My WebLink About065-310-030....... ... ` -- ------'--- -'-' -- --r-'' - `' -----------='— --� -`` �^~~ � -` 65-31-30 -Glefi'Huntert$VW1 (V111747 contr: Don Darby, Magalia ~' �GAS. SUPPORT 'STRUCTURE REQ. /t/V ^ COMPACTION TtST REQ. lUt) � | � � -itldl 911177contr:Para.Mod.Concep,ts, - ParadisePermit #3286-�7MH;i � } ' Issued ;Z,4ZgZ2 ' v i ' 65-31-30 Permit #5132Li--77B(h�ew deck/MH) h ' ^ � 65-31-30 � � . . . � 1 ia. g r ag7e] ' 65-31-307 � . contr: Lloyd R. Roberts, Magalia Permit #6239-78B,E(additional footage � � , � 65-31-30 Glen Hunter ' l 14821 Goldcone Dr., Magalia ' | Skellcraft Const., Para. �contr: � � � > - |&41 ^ °i ] _ ° � ' ) | / �I _ CW2 r PERMIT NO. 3966-81B PERMIT EXPIRES OWNER Glen Hunter CONTR. Skellcraft Const., Paradise ASSESSOR PARCEL 65731-30 LOCATION 14821 Goldcone Dr., Magalia G� W N } Temp. Power Pole Called PG&E Temp. Elec. Service Called PG&E Temp. Gas Service Called PG&E JOB FINALED(D te) I Signature ' V = OK 0 = Not OK - - = Not Applicable MOBILEHOMES MISCELLANEOUS = Not Ready Date MOBILEHOME UTILITIES (Plans) OK except #'s Date DECKS f_COVERS,_04RPORTS, ETC. (Plans) U . cxcept N . 1, Zoning Requirements—Setbacks—Easements 1. Z_gpirrg Requirements—Setbacks—Easements 2. Soils; Special MH Support—Sketch 2. Ings; Size—Depth—Spacing-Connectors 3. Sewer; Location—Test—Fall-C/0—Concrete 3.,Jlsek�rs and/or Joists—Decking—Bracing—Stairs—Rails 4. Water; Location-Test—Easement Needed (Sketch) 4AKod Awn.; Posts—Beams—R(trs,—Connec.-Shthg.—Rfg. -Bracing 5• Electricity; Location—Clearances—Grnd.—/ / Amp—Concrete 5. Alum. Awn.; Columns—Connections—Splice—Decal—Enc,os;res 6. Gas; Location—Test—Wrap:/ /"L"ft./ /"Nat. or/ /"L"ft./ /"LPG 6. Carports; Windows—Doors 7. Utility Clearance 7. Elec. Card -BI Date Card -BI Date Card -BI Date Card -Bl. Date Card -BI Date Date Card -BI Date MOBILEHOME INSTALLATION (Plans) OK except k's 1. Zoning Requirements—Setbacks—Easements Card -BI Date Date Card -BI Date POOLS'(Plans) OK except N's 1. Setbacks—Easements 2. Footings: Size—Spacing—Marriage Line 2. Soils; Compaction—Structure Stability 3. Gas; MH Test—Demand—Valve—Connector 3. Pool Structure; Steel—Connections—Thickness—Dead Men—Lining 4. Electricity; MH Test—Crossovers—Breakers—Clearances 4, Elec.; Receptacles and Lighting; Distances—GFI 5. Drain; MH Test—Fall—Flex Connector 5. Elec.; Pool Lighting; 15 volts—GFI 6. Water; MH Test—Regulator—Connector 6. Elec.; Enclosures; Conduit Entries—Terminals—Listed 7. Water and Sewer Connected—C/0 to Grade—HD Approval 7, Elec.; Bonding; Metal w/5'—Circulating Equipment—Heater 8. Gas and Electricity Tagged 8. Elec.; Grounding; Equip. w/5'—Circulating Equip.—Pool Lghtg. Boxes—Enclosures—Panel boards—Ins. to Main. in Conduit 9. Exits; Insp.—Sketch 10, Cert. of Occupancy 9. Health Department Approval 10. Plumb; Cir. Test—Water Supply Test Card B-1 Date Card -BI Date Card -BI Date Card -BI Date Card B-1 Date Card -BI Date Card -BI Date Card -BI Date J = OK 0 = Not OK = Not Applicable = Not Ready RESIDENTIAC'(Sin-gle and Duplex) Date UNDERFLOOR (Plans) OK except#'s 1. Zoning requirements -Setbacks -Easements 2. Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Dept 3. Ftg., Garage; Soils -Steel- / P Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab 6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab 7. Piers -Fireplace Ftg.-Steel 8. D.W.V.: Fall -Fittings -Test -2 way C/0 -Sewer Test 9. Gas Pipe; Size -Anchors 10. Water Pipe; Test -Anchors -Regulator -Service Test 11. Electric; Underground 12. Plenums & Ducts; Clearance -Material -Support -Ins. 13. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date PLUMBING (Permit) OK except #'s _ 14. Water Ht.; Vent -Access -Combustion Air 15. Water Pipe; Test & Anchors -Nail Protection 16. D.W.V.; Test-Fttngs & Anchors -Nail Prote:tion 17. Shower Pan; Test, First Floor -Tub Access _ 18. 19. Test Tub & Shower, 2nd Floor -Tub Access Gas Pipe; Size & Anchors Plywood on Roof Overhang -Attic Vents -Rafter Outriggers Siding -Nailing -Veneer Date Card -BI Date Date FRAMING (Continued) 48. Property Line Firewall & Openings Elec. Outlets at Wood Panel; Int. & Ext. 49. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits Date Card -BI Date 50. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance 51. 52. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers Siding -Nailing -Veneer Date Card -BI Date 53. Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access Elec. Outlets & Receptacles at Kit. Counter 54. Glazing Area -Glass Protection -Skylights -Plastic 40. 55. Shear Walls; Nailing -Bolts Garage Fire Door; Swing -Landing -Closer Date ELECTRICAL Permit OK except #'s 68. A.C. Duct in Garage -Damper 20. Card -BI (NOTE: An entry must be made Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date FINAL (Plans) OK except #'s 56. Ext. Steps -Door & Sidelight Protection -Landings 57. Smoke Detector 58. Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 59. Bedroom Exiting 60. G.F.I. & Bath Fixtures & Tub Access 61. Elec. Trim & Subpanel; Breaker Sizes -Labels 62. Stairs & Rails 63. Fireplace or Stove; Clearances -Hearth 33. Condensate Drain & Overflow; Size & Grad=_ _ 34. 64. Elec. Outlets at Wood Panel; Int. & Ext. Card -BI Attic Access Platform if Furnace in Attic Date Card -BI Date -& Card -BI- Date _ - _-Card-BI Date Card -BI Date Card -BI Date 65. Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance Card -BI Date FRAMING(Plans) OK except #'s Date Card -BI Date Sills; Proper Material & Anchors _ _Walls; Studs -Nailing, Spacing & B_racing-Plates-Sound Bearing WaIIs over Girders & Floor Nailing-- _- Draft Stop in Walls (rat proof) 66. Elec. Outlets & Receptacles at Kit. Counter 40. Fire Stops; Furred Ceilings -Stairs -Chases -Tub 67. Garage Fire Door; Swing -Landing -Closer Date ELECTRICAL Permit OK except #'s 68. A.C. Duct in Garage -Damper 20. Fixture & Transformer Clearance -Ins. Protection (NOTE: An entry must be made 69. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.- 21. Elec. Receptacles Spacing -Lights &Switches at Doors In Garage; Above Floor-Mech. Protection 22. Size Boxes & No. of Conductors -Stapled 70. Plb., Elec. &Mech. Equip. Listed for Location 23. Romex Installed Close to Edge of Studs & C.J. 71. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec. 24. Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water 72. Insulation -Foam -Looked in Attic E] Yes 25. 2 Appliance Circuits in Kitchen &Conductor Size Guard Rails & Deck Construction -Post Caps 26. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or AI 74. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked ❑ 27. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al, under Floor Yes 75. Following ❑ instld.: Drive Yes No; Walks ❑ El Yes El No; Insulated Neutral ❑Yes ❑No Planters❑Yes ❑No 28. Service -Riser Conductors & Ground -Main Disconnect 76. Stucco; Brown -Finish 29. Equip. Clearances; Panels-Motors-Mech. Equip. 77. A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet - 30. Clothes Closet Light -Shower Light 78. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs. ---- - 79. Water Well; Disconnect, Electrical, Plumbing - 80. Exterior Elec. Trim; G.F.I. Receptacle -Underground Card B -I Date Card -BI Date 81. Ventilation throughout House Card B -I Date Card -BI Date 82. Glass Protection 83. Corrections from Previous Inspections Date MECHANICAL (Permit) OK except #'s 84. Gas Test -Meters Tagged; Gas -Electric 31. A.C. Ducts; Insulation & Support 85. Water & Sewer Connected -C/O to Grade -HD Approval 32. Vent Fan; Exhaust above Insulation 86. Energy Compliance Certificate -Other Certificates 33. Condensate Drain & Overflow; Size & Grad=_ _ 34. Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet 35. Attic Access Platform if Furnace in Attic -& Card -BI- Date _ - _-Card-BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Comments at Final: Date FRAMING(Plans) OK except #'s _ 36. 37. 38. _ 39. Sills; Proper Material & Anchors _ _Walls; Studs -Nailing, Spacing & B_racing-Plates-Sound Bearing WaIIs over Girders & Floor Nailing-- _- Draft Stop in Walls (rat proof) 40. Fire Stops; Furred Ceilings -Stairs -Chases -Tub 41. 42. 43. 44. 45. 46. 47. Header & Beam -Size & Bearing Hangers -Post Caps -Anchors -Connectors Cing. Joist-Rftr. Ties-Purlin-Root Brac.-Truss-Shthng.-Ring. Fireplace Ties or Type A Flue -Fireplace Throat Atli c Access: Size & Romex Protection -Draft Stop -Ins. Baffles Bdrm_Windo_ws or Exiting Doors -Sill Hgt. & Dimensions Garage Fire Protection Framing (NOTE: An entry must be made each time you visit job site) COUNTY OF'BUNTE - DEPARTMENT OF PUBLIC WORKS k /l `PERMIT NO. • - ''7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4 APPLICATION AND' -PERMIT ASSE COR PARCEL N BER V__3 _ / _ go , ZONING B ILD G P RMIT OWN R 4- V L _r_�� 1� TELEPHONE SQ. FT. OCC BUILDING VALUATION t Ilo OWNER'S MAILING ADDRESS CONT ACTOR'S N�IE K //OX.4F-- caki &7— TELEPHONE 977.3610. CO R CTOR'S M ILING ADDRESS /2- _ _ �L_t� CONSTRUCTION LENDER UNKNOWN Fireplace Total Valuation $ 1 Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER �/L\�° LICENSE NO. I Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILDING ADDRESS PLUMBING PERMIT Filing Fee 10.00 Lmo_ Each Trap 2.00 Repair drainage or vent piping 5.00 Water piping LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF ❑ Duplex[] Mobilehome'X Other SPECIFY Building sewer Lawn sprinkler system 5.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ instal lation ❑ Other Describe work: AI, 00 �� JZr' `�L�� Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 100 AMP ORSLESS 5.00 Main service EA. ADD'L 100 AMP 2.50 DWELLING OCCUP.) NEW CONST. ( y OR ADDNS. ACC. SLOGS. 22 sq ft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): Erli-am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No.,?y0 6O�-% Classification 16 ❑ I, 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) EJI am exempt under Sec. , Business and Professions Code for this reason NEW NON.RECID PL BRANCH CTRCT Ts 2.50 ea NEw CONSTR (POWER APPARATUS D NON-RESID. (SINGLE OUTLET CIR. 509250 Ex. Occup o DR FIXTURES BAL91o¢ FXED PPLNS, OR XED A Ex. OCCup.(OUITLETS (RESID•) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 7.50 Permit Fee $ Contractor MECHANICAL PERMIT FiIingFee 10.00 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. Heating Cooling Hood 3.00 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 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 liabilities, judgments, cost and expenses which may in any way accrue against said ounty in cons q nc the granting of this permit. (3 X Date �� ` �� 7 Signature of Applicant — Owner ❑ ntractorZ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ V,3P occuP. GROUP I TYPE OF CONST, �� A/ Y PARCEL v PD ND ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTO OF PUBLIC By PE EXPIRES Date the applicable provi- resolutions to do fees have been _paid. WORKS Date / Receipt No. b& Z' WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT i F PERMIT NO. 5132-77B 000 PERMIT EXPIRES �! OWNER Glen Hunter CONTR. owner LOCATION (A.P. 65-31-30 1315 Goldcone Dr., lot 65, PP#I, Magalia Temp. Power Pole Called PG&E Temp. Elec. Serv. Called PG&E T mp. Gas Serv. Called PG&E JOs 6� L— FINALED (Date) r (Signature COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION REC-ORD BUILDINP BUILDING (Cont'd)I PLUMBING Setback Firewall Soil Piping Forms <y` Parapets 1st Floor Main Bldg. DRestroom Finish 2nd Floor Footings Windows 3rd Floor Stemwall Sidinq To out Slab Roof Sheathing Water Piping Piers Roofing Sewer Garage Fdn. Vents Fixtures Footings StemwaI l Garage Vents Insulation Water Htr. Heaters Slab Car ort p Footings Prov.'for ph slcally handicaped Conformance of ex. structure n.Temp. Appliances Gas Piping & Test Gas Slab Final Z ` Sanitation Patio FIREPLA _ Final Footings Footing ELECTRICAL Relnf. Steel I Final I Fixtures Framing Test I Water Htr. Stucco I Final I Suhnanels mesn MECHANICAL Grd. Fault Prot. Scratch Heating 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 MOBILEHOME INSTALLAT! ON - - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE REMARKS OR CORRECTIONS /��fl /� � / �7 �� ./�,� /w � ��,�ivr�-�✓' GFS (NOTE: An entry must be made on this form each time you visit the job site.) ,h ` COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County CenteyDrive,,-- U'roviIIe, California 95965 ~� Tel epgone: 534-4541 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above- entioned property for inspection purposes. F X Date Signature of Permi ee or Agent Receipt No./ •� O®�� , 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 b?aid. DIRECTOR OF AUBLIC WORKS By Date/ -o-6-7,7- /�`� �'— -7,Ti,dIng permit expires Date BUILDING Owner ��'� U 1-1 7—C IL, SO F OCC. BUILDING VALUATION k3 6 0 Mailing Address ! / 3 7`kA % n �/,L ,Z Telephone No. Fireplace Contractor ( `P 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 L L7 - 0(\/ t- 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. 3 (^ 3 C)' Zoning & Planning Gas piping system 1 - 5 outlets 1.5101 Each additional outlet .30 F e W. . S ) FireDept. FireZone Use Permit Building sewer 5.00 EQA P Plans Parcel Declaration Parcel Map P 60' R/W Improvements P Lawn sprinkler system 2.00 Bldg. Plans Recd Parcel Approval Picks Approval Permit Fee $ $ NEW ADDITION ❑ UTILITIES ❑ OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 600v OR LESS 5.00 100 AMP OR LESS Main service EA. ADD'L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home Others ❑ OVER 600V Main service 00 AMP OR LESS 25.00 Main service EA. ADD•L 100 AMP 1.00 NEW CONST. I DWELLING OCCUP. & OR ADDNS. ACC. SLOGS. 20sgft 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 st le of: y Ex. Occup(OUTLETS OR FIXTURES)50 @25C 104 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 [Si 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 • $ $ 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby TOTAL PERMIT FEE $ authorize representatives of the County of Butte to enter upon the above- entioned property for inspection purposes. F X Date Signature of Permi ee or Agent Receipt No./ •� O®�� , 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 b?aid. DIRECTOR OF AUBLIC WORKS By Date/ -o-6-7,7- /�`� �'— -7,Ti,dIng permit expires Date ti PERMIT N0. T2726-77P,E PERMIT EXPIRES OWNER Glen Hunter CONTR. Don Darby, Magalia LOCATION (A.P. 65-.31-30 1315 Goldcone, lot 65, PP#l, Magia Temp. Power Pole i Called PG&E,--',' Temp. EleServ. Calle/PG&E,�rr Temp /Gas Serv. Called PG&E JOB FINALED (Date) (Signature) ` r 9. Electrical A Is service large eno<<glt to provide adequ<it_e amperage to mobilehome (must equal rating of mobilehome faith a. :::inur:um of /100 amp) and other faciliti_�is on lot, i.e., water pumps, g.:raUe, cabana, et c.`l ✓ Yes No B Is there proper clearances around panels? Yes ✓No_ C. Is power supply cord or feeder assembly properly fused? Yes -1�10_ D. Is continuity test satisfactory as per the following procedure? Yes✓No 1. De -energize electrical wiring syste:ai 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 l ad of a test instrument to the mobilehome grounding conductor and apply the Gi_IAeL' .LI:dU to eaCAi iIIUIJL.LCtlGnit'_ supply CondLiCto, i1lCliiGliig iieili.l'dt. 5. All nor. -current, carrying metal parts of the mobilehome (aluminum siding, gas line, iter line), including fixtures and appliances, shall be tested for .continuity from, such equipment and the grounding conductor. 6. Upon completicn 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 shall then be made between the grounding electrode and the chassis of the mobilehoie.. Unon satisfactory completion of the electrical tests, the lot or site service equipment may be approved for energizing. 1,; job card signed by Health Department for water and sanitation? 1:.. If everything ol:ay, sign. off card and ta,- services. MOBTLL;? ME DATA Manufacturer and/or Namestyle c Lergth�_ Width Vehicle Serial No. 2 g cLc7 State Identif icat:i..on No. ��Qi3 ?Y'70 Adei"tional Infoi-nat-ion or Comments: Y i MOBTi,'r,,11101ME, INSTALLATION INSPECTION CHECK LIST 1. Is the. mobilehome locatedwi.lI required separation from lot lines and buildings and generally conform to plot plan? Yes �No 2, Does the ,mobilehome have required clearances above ground? (Sec.5085) Yes '---'No 3. Are foot.in-1,s 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 '-""No 5. If more than a single unit, are crossover connections properly installed? (Sec. 5088) Yes ✓ No y: Water A. Is flexible connector.of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes ✓ No B. Test - Does water piping withstand working pressure or 50 lbs. air test? Yes i --No C. Backflow - If coach is not State of California approved, does station have backflow device and pressure -relief valve? Yes No f 7. Wastes and Drains A. Is connection made with. Schedule 40 DWV and have flex connectors at each end? Yes L" -No B . Does it have minimum I," per foot slope and is it properly supported? Yes __"No C. Are any leaks detected in drainage.system.after running 3- allons 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. 'rest 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. Cor_necc gas meter to mobilehome with connector, turn. on gas, test connections with soapy water. C. Are all appliance vents properly installed? Yes �/ No COUNTY OF BUTTE — DEPARTMENT. OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDINGBUILDING (Cont'd) PLUMBING oeTVaCK ewaII Sati Piping Forh PAPets 1 t Floor Mai Bldg. Rest om Finish 2n Floor Fo ins Windo 3rdNoor Stem all Siding To out Slab Roof Shehing Water Pipi Piers Roofing Sewer Garage Fdn. Vents Fixtures Footings Garage Vents Water Htr. Stemwa I I Insulation Heaters Slab Carport p Footings V Prov. for ph sical handica ed Conformance of ex. structure V Appliances Gas Piping &Test Temp. as Slab Final Sanitation Patio IRE! ACE Final Footings Footing EIECTRIA L Reinf. Steel/ 0 LF[nal / 0 I Fixtures / Framina Test Water Htr. Stucco X Final Subpan XBn MECHANICAL Grd. F It Prot. Heat Servl Co Ing T mp. Pole Dcts nder round h entilation Permanent oor Closer Final Ina[ MOBILEHOME UTILITIES ------ Elec_ Service -�� Z Elec. Pedestal Water Piping -7-/F--?) Sewer - IKr77 Gas Piping MRB16EHOME INSTALLATION - - - - - - - - - A - • - - Support !/ Elec. Continuity Water Piping Drainage Gas Piping DATE REMARKS OR CORRECTIONS (NOTE: An entry must be made on this form each time you visit the job site.) 41 COUNTY OF BUTTE DEPARTMENT OF PUB1,IC WORKS , , 7 COUNTY CENTER DRIVE OROVILLS, 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 Tfor the following location: Owner— Owner's wner Owner's Address w' Atobilehome Mfg. -A � J L !CA 1--+ Y- Model �J*Lhb_ Year 77 Insignia No.7)1 73 -71/ '7-' Serial No. 99 It is hereby certified for occupancy at the above described location and may be occupied. Director of PublicWorks Date q—% _ 7-7 By /_/.l��'1`. THIS CERTIFICATE IS VOID WHEN 4OBILEHOME IS RELOCATED COUNTY.DF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive Oroville, California 95965 Telephorie: 534-4541 AlAPPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X L��%�� Date Signature of rmitee or Agent Receipt No. No 10q�,� 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 O'F\PUBLIC WORKS By Date 7-1cl-77 B I Iding permit expires Date 7—/f— 7f BUILDING Owner " 11-7) Q. FT. OCC. BUILDING VALUATION pt— Mailing Address Telephone No. Fireplace Contractor -Thtal Valuation Mai lin Address 3 Permit Fee Plan Checking Fee &/or Penalty ele ho Permit Fee $ . Building Address - SOT PLUMBING No. @ FEE PERMIT FILING FEE $3.00 TI �, Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 / G A. P. No. COJ -- �` v Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 FeeW.C. Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration Parcel Ma P 60' R/W Improvements Lawn sprinkler system 2.00 Bldg. Pec'd Parcel pproval Plans proval Permit Fee $ $ �—y NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 V v 6001 OR LESS Main service 100 AMP OR LESS 5.00 Main service EA. ADD'L 100 AMP 2.50 Main service OVER 25.00 100 AMPP OR LESS O Single Family ❑ Duplex ❑ Mobil Home ethers ❑ Main service EA. ADD'L 100 AMP 1.00 NEW OR ADDNST /DWELLING ACCOCUP. & BLDG ) 22sgft NEW CONSTR. MULTI -OUTLET NON.RESID. ( BRANCH CIRCUITS) 2.50ea NEW C ON ST R. ( POWER APPARATUS & NON•RESI 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 st le of: y Ex. OCCup(OUTLETS OR FIXTURES)@� BALD/ Ex. OCCU FIXED APPLNS. OR P• OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 / License No /L Classification ��(� Misc. Wiring 6.25 ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ MECHANICAL No. @ 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. 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. 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 TOTAL PERMIT FEE $ d authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X L��%�� Date Signature of rmitee or Agent Receipt No. No 10q�,� 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 O'F\PUBLIC WORKS By Date 7-1cl-77 B I Iding permit expires Date 7—/f— 7f 1. Owner's name: 2. Installer's n BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Orovill•e,'CA. PHONE: 534-4541' MOBILEHOME INSTALLATION SHEET 3. Is the site currently under permit? Yes. No ( If yes, furnish permit number Is the site an existing site? Yes / / No (If yes, furnish two (2) plot plans.) M 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? ------- -------------- ��(� Amps 6. What is the mobilehome site service rating? --- . --- -- 11 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.) Q/� ---- / T T/1 10. What is the type of gas service? -- --- ��-��•---��==='z—� Natlsr�r--�� v / 11. What is the gas pipe length from meter or tank to the mobilehome? (ft.) 12. What is the mobilehome gas demand? ------------------------------ "(This information not required if pipe length less than 6 ft. on natural gas or less than" -50 ft. on LPG.) (BTU) MOBILEHOME SUPPORT DATA Of Mobilehome Mfr. �.��/ G��G/�it� ''v Setup Model No.1 �� Ov Year Width —:?6,1_(ft.) Length ./-.'g7 :.. (ft.) Expando Size ft.x ft. (Draw support details below) On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation manual and rstq-,Iura,,_setuP sheets (if not on .file with the County of Butte). S —3*ncr le Footings (check one) ; Center Center Support Support Footing Sizes Locations (in.) /4,C -U - --- - (rt�-� 1� )' v ( (In. 12 M - (in.) (in.)(in.) VAU * ^ter piers are other th4brawn above, draw in locations, spacing, and dimensions. Wood -either . pressure treated or fdn. grade. 2. Concrete pad. r 3. Other,: specify Supports (check one) /7� 1. Concrete block 2. Concrete piers 3. Steel piers 4. Other, specify ��1-�Footing Size Typical Support t x v in. in. Max. Pier Spacing in.) i Max. Overhang evrtE r,0uNT'f BuiLopfi A PROV60 9 COUNTY OF 6UTTE� — DEPARTMENT OF PUBLIC WORKS ' 7 County Center Drive Ureville, 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 . za4Date - 7 7 Signature of Perrmiitee or Agent 41 Receipt No. I I I 5- Sy 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 OFPr) C WORKS By , , Date 9--/ (. - -2.7 v G —/(. —7P Building permit expires Date BUILDING 7,1 71 Owner (9L VV- gQ P177 &M • SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace Contractor D Q 111 (/1, \, Total Valuation Mai l Ing Address 5 V 'e/\/ tl,Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ $ Building Address PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 3 '' 13 Q L Each Trap 1.50 QI • /.. Repair drainage or vent piping 1.50 Water piping 4s5P1' [0, irimu Each gas water heater or vent 1.50 C^ % %C A. P. No. �'`J 3 `J �J Zonin Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fe S iiP FireDept.FireZone Use Permit Building sewer -J-90EQA Parking Plans el Declaration Parcel a P 60' R/W Improve p ovem s Lawn sprinkler system 2.00 LoFQh3n ec'd I Parc Approval Plans i Koval Permit Fee $ NEW ❑ ADDITION ❑ UTI LITIES� OTHER El ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 3` Main service 600V OR LESS 5.00 100 AMP OR LESS Main service EA. ADD•L 100 AMP 2.50 pC Single Family ❑ Duplex ❑ Mobil Home Others ❑ OVER 600V Main service 100 AMP OR LESS 25.00 Main service EA. ADD•L 100 AMP 1.00 SQ. FT. MINIMUM oR AODNS. ( DWEACCLBL GLING OCCUP. &) 20sgft NEW CONSTR. MULTI -OUTLET NON.RESID. ( BRANCH CIRCUITS) 2.50ea WBILES " 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 Busine s & Profess. s Code under the name style of: y Ex. Occup(OUTLETS OR FIXTURES)@L�C BAL�1 EOFIXED APPLNS• OR Ex. ccuP• 2.00 OUTLETS (RESID•) EA) Temporary service 10.00 Mobile Home Facilities 15.00 ,S License No. 3 z -7 Classification Misc. Wiring 6.25 ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ Is MECHANICAL No. @ 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 JIOIJ 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. PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 1 1 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 &0 go L ems~ AS7 TOTAL PERMIT FEE $ 3 authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X . za4Date - 7 7 Signature of Perrmiitee or Agent 41 Receipt No. I I I 5- Sy 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 OFPr) C WORKS By , , Date 9--/ (. - -2.7 v G —/(. —7P Building permit expires Date n PERIAI;. NO. 5802-78B,E PERMIT EXPIRES OWNER Glen Hunter CONTR. Lloyd R. Roberts., Magal;a 65-31-30 LOCATION (A.P. ) 1315 Goldcon e Dr., lot 65, PP#l, Magalia ` f lS� J` (r Temp. Power Pole Called PG&E Tem .Elea Serv. Called PG&E Temp. Gas Serv. Called PG&E JOB FINALED (Date) - (Signature) COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECT'iON_.RECORD BUILDING BUILDING (Cont'd) '7�S tba k handicapped F . Appliances PLUME'ING Carport Footings Slab Firewall Soil Pipin ' Forms Parapets 1st Floor Main Bldg. Restroom Finish 2nd, Flool Footings Windows //, %, Z y 3rd Floor Stemwall Siding 11-7,1 - 7 F To out Slab Roof Sheathing/ jj/`" % �� Water PI in Piers Roofing 11-7,1---r? Sewer Garage Fdn. Vents Fixtures Footings %Garage StemwaI1 /0 7,r Slab � ZZ -7 V 0;?- Vents Insulation Prov forh sicall Water Htr. Heaters handicapped F . Appliances PLUME'ING Carport Footings Slab Conformance of ex. structure Final - / % Gas Piping & Test Temp. Gas Sanitation Patio FIREPLACE' Final Footin s Footing ELECTRICAL Masonry Walls Throat Rough - 7 Reinf. Steel Final Fixtures "/-tv Bond Beam FIRE RINKLERS Motors Framina //- Test we.s. u.. Mesh rinai Subpanels MECHANICAL Grd. Fault Prot. Scratch Heating Service Brown Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation Permanent Door Closer Final Final MOBILEHOME TILITIES-------------=---- Elec. Service Elec. Pedestal Water Piping Sewer Gas Piping. OBILEHQME INSTALLATION - - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping G/lG�E i S Ga /LLOS% DATE &46 OR 6 % U / ILS CQN�v 0 f%G �i 0!/ew 4"VYi REMARKS OR CORRECTIONS / � /� •5 � ce-cam ." � (NOTE: An entry must be made on this form each time you visit the job site.) COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 Coun,ty Center Drive - Oroville, California 95965 Telephone: 5344541 APPLICATION AND PERMIT autnorize representatives or the county Or butte to Anter upon the e d` r Receipt No. !tt 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. DIRECTOR OF PUBLIC WORKS 1-MAZI IN, u Building permLxpires DaVe—'�VA BUILDING r� N/ Owner Pr ,/t%-%��, /vli�S LC SO. FT. OC BUILDING V ATION Mailing Address � Tel epkone No. Contractor 1.p yD /2V O&Ars nn Mailing Address �0 . /�frJX /09 Fireplace Total Valuation � 7 j�l kon^OS-9 IDP—. Permit Fee Building Address Ir 131-6 o4-r,>cvAJC Plan Checking Fee&/or Penalty Permit Fee PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 A. P. No. 6�.3 )^3� Zoning & Planning Water piping 1.50 Each gas water heater or vent 1.50 s W Sa Fire Dept. Fire Zone Use Permit Gas piping system 1 - 5 outlets 1.50 EQA Parking plans Parcel Declaration Parcel Map 60' R/W Improvements Each additional outlet .30 Building sewer 5.00 BI ns ec Parcel A proval Plans Approval Lawn sprinkler system 2.00 NEW ❑ ADDITION UTILITIES ❑ OTHER ' Permit Fee $ $ Q/ %O/(oTO ELECTRICAL No. @ FEE P 5$02-7 PERMIT FILING FEE $3.00 3,,J%0 800V OR LESS Main service 100 AMP OR LESS 5.00 �-�/ Single Family ❑ Duplex ❑ Mobil Home ❑ Others 17 Main service EA. ADD'L 100 AMP 2.50 ��n (J (-�7 /T Main service OVER 600V 25.00 100 AMP OR LESS Main service EA. ADD'L 100 AMP 1.00 NEW OR ADDNST. I DWELLING %ACC. SLOGS. 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:Ex. Coff C;, / �� NEW CONSTR BRANCH CIR T NON-RESID f, BRANCH CIRCUITS) 2.50ea NEW CONSTR. POWER APPARATUS 8 NON-RESID. ANGLE OUTLET CIR. Ex. Occur)(OUTLETS OR FIXTIIRES 5 L25 Occup.(FIXED APPLNS. OR OUTLETS (RESID,) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 722/ 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 Wor n Compensation. have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. E] 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. 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. @ FE_ E PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ Land Development Fee $ is TOTAL PERMIT FEE $ autnorize representatives or the county Or butte to Anter upon the e d` r Receipt No. !tt 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. DIRECTOR OF PUBLIC WORKS 1-MAZI IN, u Building permLxpires DaVe—'�VA COUNTY OF BUTTE DEPAF(TMENTOFPUBLIC..W&RKS 7 County Center Drive — Uroville, California 95965 ' .. Telephgnet 5.3,4-4541 APPLICATION AND PERMIT authorize representatives of the C my f Butte to enter upon the above-mentione erty r in do rpo S. ate Si re f Permiiteee(oor Agent Receipt No. ` I n 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 �p B ing permit expires Date BUI DING Owner F� SQ. FT. OCC. BUILDING VALUATION TIW*41/o Mai I ing Address Telephone No. Fireplace Contractor Total Valuation Mailing Address ,, ®� 2 Permit Fee Plan Checking Fee &/or Penalty +u Tel hone No. fV Permit Fee $ -2,q XG � Building ddress PLUMBING No.1 @ FEE PERMIT FILING FEE J$3.00 ./�. Each Trap 1.50 e q c� - C� c� Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 g�1 A. P. No.JV Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 F C. S io ire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Par ing Parcel Plans Declaration Parcel Ma 60' R/W Im rove nts P Lawn sprinkler system 2.00 Bldg. P ons Recd Parcel Approval P s pproval Permit Fee $ $ NEW ADDITION ❑ UTILITIES f07THER ❑ ELECTRICAL No.1 @ I FEE PERMIT FILING FEE $3.00_0 Main service 800V OR LESS 5.00 100 AMP OR LE55 Main service EA. ADD'L 100 AMP 2.50 Main service OVER 600V 25.00 100 AMP OR LESS Single Family ❑ Duplex ❑ Mobil Home Others Main service EA. ADD•L 100 AMP 1.00 rr si1L/r C. NEW CONST. / DWE OR CCUP. & ) 22sgft c�qOU L T NEW CONST(LOT U TI NON-RESID, (BRANCH CIRCUITS) 2.50ea NEW CONSTR. (POWER APPARATUS & NON .R ESID. 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 of: style of:A � c r �� Ex. Occup(OUTLETS OR FIXTURES)50 @Z# BAL@1 Ex. Occup (FIXED APPLNS. OR 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 $ L $ Z WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which vires every employer to be insured against liability for Wor n's Compensation. have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. r -1I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby TOTAL PERMIT FEE $3 authorize representatives of the C my f Butte to enter upon the above-mentione erty r in do rpo S. ate Si re f Permiiteee(oor Agent Receipt No. ` I n 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 �p B ing permit expires Date