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Home My WebLink About065-310-04665-31-46 SBO GOODMAN 148'36-'-- o one lir; -lot'-1-0-2--P' ,-1-lagal .PErmit#2293- E(TIL, MH) ELEC GAS i / " LP COMPACTION T ST RE�� _SUPPORT STR RE ��3s �.. - 65=31=46 C Permit#2 7MHI Issue - e% 065-31-0-046 923748B GOODMAN, Bonnie 14836' Goldcone`, Magalia :carport/mh Tt� F T ' C�CoS ' 3 •f CJ a.v t%,Tr-7g:. e •J - i • T i t • �i i; a UMIKOTMIM eftwt* q,J&tte OROVILLE, CALIFORNIA GENERAL CLAIM CLAIMANT: Quality Maintpnanrp ADDRESS: 13783 Gilfillan Dr, CITY &STATE: - Mag-alia. CA 95Q54 IMPORTANT: SEE INSTRUCTIONS DATE OF CLAIM: January 22.'1993 �ON REVERSE SIDE SUBMIT CLAIM TO DEPARTMENT. RECEIVING GOODS OR'SERVICES DATE 'DESCRIPTION OF CLAIM (DESCRIBE- FULLY TO AVOID DELAY) Owner has decided not to do work. Permit #92-3748B AP#065-310-046, Receipt #122832, dated 10/22/92. —AMOUNT Total Permit Fees Paid--------=----------------------$66.50 Rptnin P1,qn ChprkinR FPP ------------------ $20-00 Retain Building Permit Filing Fee---- 15.00 -Total Permit Fees -Retained--------------------------- 35.00 TOTAL REFUND DUE -------------------------------------$31.50 TOTAL $31 50 1, the undersigned, declare under penalty of perjury that the services or articles claimed have been performed or delivered, and that this claim is true and correct as stated. Dated this ,;'A ............. day of ............................ . 19 ..................... at....; Calif. ......... ; .............. .................................... §ignature..of CTaimant 1, the undersigned, hereby certify that, to the best of my knowledge. the services or articles specified above have been performed or de- livered and that there is a Budget AppropriationE] or Specific Board Approval F-1 (Check one) for.1he same. Dated this ......... 22nd ............... day of ... Januar..y ..... ig.93, at Dr.o.Kilig ...... , callf. ................................. . ................ Di-partment Heed or Authorized Deputy Dept. Exp. Code ......... 4.4()__GG2 .............. Code ...... 42-10500 ..................... PAYABLE FROM ..... .jnj.t.P .............................................. FUND DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY DEPT. & SUB. PROD. SUB. OBJ. CLAIM NO. INV. NO. INV. DATE ENCUMB. GROSS AMT. 4 COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 / County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 �`• APPLICATION AND PERMIT PERMIT NO. ASSESSOR/PA��- NUMBER 065-310-046 ZONING E-1 I _,We BUILDING PERMIT OWNER BONNIE GOODMAN TZLEPHONE 873-4293 SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS P.O. BOX 1719 PARADISE 95926 120 C 1,560 CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ f 560 LENDER'S MAILING ADDRESS Filing Fee $ 15.00 Permit Fee $ 31.50 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ 20.00 ARCHITECT OR ENG.NEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS 4 Permit tee $ 66.50 PLUMBING PERMIT Filing Fee 15.00 Each Trap 1 5.00 Solar or heat pump water heater 20.00 LOT NO. 102 1 SUBDIVISION NAMEPARCEL PPMHE #1 MAP Water piping 7.00 Each pas water heater or vent 7.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome❑ Other CARPORT 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 New [3 Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other ❑ Describe work: Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 2000A OR LESS 18.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (Check one): ❑I am licensed under p provisions of Cha t. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification 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) ❑ I am exempt under Sec. , Business and Professions Code for this reason Main service 200ATO1000AI 37.50 NEW CONST./ DWELLING OCCUP.&) OR ADONIS.1 ACC. BLDGS. 3.6Qsq.ft. NEW CONSTR ULTI.OUTLET NO N.RESID BRANCH CIRCUITS) @ 5.00 (POWER APPARATUS &) I SINGLE OUTLET CIR. Ex. P OUTLETS OR FIXTURES 20 fid LL Ex. Occup. OUTLETS (RESID )KEA.) I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 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. RN;? 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 FiIingFee 15.00 Heating Cooling g Hood 6.50 Ventilation Perrnit 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 Countyot 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, judgmen costs, and expenses which may in any way accrue agait sa Co consequence pf the granting of this permit. X ' y D Signature of A li nt — Owner ❑ Contractor ❑ Agent gpk An OSHA over 5'0" deep and demolition or construct- ion of structures toverr3gstCorriesoin height. Mobile Home Installation Fee S Energy Inspection Fee $ Occ CONST TYPE TOTAL FEES 66.50 HAz I DFEES I IMP I FLOOD I COF PARCEL I PD I HD ISSUE This permit is hereby issued under the sions sions of the Butte County Code and/or work indicated above for which fees DIRECTOR OF PUBLIC By PERMIT EXPIRES Date applicable provi- � resolutions to do have been paid. WORKS Date Receipt No. v 2—X--- WMITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE PARTMENT OF PUBLIC WO, BUILDING DIVISION 7 COUNTY CENTER DRIVE - OR0.VldE,, CALIFORNIA 95965 TELEPHONE (916) 538-7541 •�. 'Wo IV PERMIT APPLICATION DATA SHEET OWNER 40n(NI %io OOf�h�d*�-� A. P. No. v.-- .31Q - 0 4I -C Proposed Building Use��A--AIT -/V 0 Building Inspector Date , ° At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1, All items have been submitted . ........................................ 2. Plot plans, 3/4 sets, signed by preparer of plans . ......................... . 3. Complete plans,.3/4 sets, signed by preparer of plans . ..................... . 4. Engineered plans and,calcs,<3/4 sets, with wet signature on plans. ' 5. Hazardous Material Form . ............................................ 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non -Heated and A/C Buildings . ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). ... . 9. Mobilehome data and manufacturer's installation instructions, 2 sets. ........... 10. Fees of$ . ........................r................ 11. Impact fees as shown on attached schedule . ............................. . 12. California Department of Forestry plan approval/fees. ....................... . Flood elevation letter (100 year flood) by California Engineer. .. ............ . V.4.Sanitation and plot plan approval 14440 -Health Department . ............. City of Chico plumbing permit . ......................................... 16. Plot plan and business license approval from City of Biggs/Gridley. ............. 17. Planning approval for (A) Use: (B) Parking: . ........ 18. Contact Land Development about (A) Improvements (B) Drainage. .......... . 19. Driveway permit (construction approval required prior to occupancy). .. r .. ... request 20. Pre -inspection for to Building Ins actorrequired. . to Building Inspector (Date) 21. Contractor's license information. (No., Name Style, Classification). ... ........,. Certificate of Workmans Compensation Insurance. .. ......... 23. Owner -Builder Verification (Given to owner' Mail to owner ......... Recorded copy of Agricultural Acknowledgement Statement . .................. 25. Letter of signature authorization . ....................................... . 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. ..... 27. Letter of intent on building use . .................................. •...... . 28. Mobilehome utility clearance . .......................................... 29. Documentation of legal access . ....................................... . 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... 31. Existing violations/expired permits . ...................................... 32. Plan check list . ..................................................... 33. 34. When issue the permit, proceskU follows: Mail to owner. Mail to contractor. Telephone Q `i- Ze5ahold for pickup atf ��/ office. Deliver with inspector. Other Parcel Creation Acreage Applicant Date �- 2� 9 Copy of Haz-Mat form sent Health Dept. Fire Dept. Air PoIlLtion Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted p • to 1. Index permit for above items No. 2. Additional items required: it issuance: (Circle new item not checked above). Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Plans checked byj`y,�l Date 10 °1ti Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works M PERMIT NO. 2293-87P E MH PERMIT EXPIRES( 020 OWNER ONNT ,.GOODMAN CONTR. iinknown ASSESSOR PARCEL 65-31-46 LOCATION - 14836 Goldcone Dr lot 102 PP#1. Magalai OFFICE COPY Address GAS Meter ELECT Meter ^�77 Dace's Temp. Pow Called Temp. Elec Called Temp. Gas Called JOB FINAL Signeh J =OK 0=Not OK - = Not Applicable = Not Ready MOBILE HOMES a • 1 MISCELLANEOUS Date MOB OME UTILITIES Plans O-exce t #'s Date DECKS,COVERS,CARPORTS,GARAGES, (Plans)OK except #'s ing Requirements -Set s -5h eW ; 1. Zoning Requirements -Setbacks -Easements . Soils; S h j 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 9 ewer; L tion- - -oncr 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails ate ; L ion- s a ) 1 4. Wood Awn.; Posts-Beams-Rftrs.-Connec.- Shthg.-Rfg.-Bracing ectricity; Lo 'on- IPA ces- d.- (NDAmp-Concrete Xv-das; Lo ion -T - • / /"L"ft. or "L ft. "LPG 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures I 6. Carports; Windows -Doors Z7j7Atility Clearance ! T Elea ' 8. Frmg; Sills-Anchors-Studs-Rftrs-Trusses ` 9. Siding; Nailing -Veneer -Stucco -Mesh Card -B1 Dat Card -B1 Date 10. Roof; Shthg-Roofing Card -B1 Da'V_ZZ Card -131 Date 11. Ext.; Steps -Doors -Landings Date —MOBILE j4OME INSTALLATION (Pos) OK except #'s 1. �ung'Requirements-Set s -Easements ' Card -131 Date Card -B1 Date ootings; Size- pacing- a ;Card -B1 Date Card -61 Date H t-DefwA4d-V -Co r 1 jktlec!j.icity; MH -Crpsseyem-Bre -CI es ; Date POOLS (Plans) OK except #'s rain; MH Te --Flex-.GoK'ector ► 1. Setbacks -Easements at , " H Test- R or -Co ( 2. Soils; Compaction -Structure Stability 7799atelaffd Sewer Connected -C/O to Grade -HD Approval r 3. Pool Structure; Steel -Connections -Thickness- Dead Men -Lining . asjand Electricity Tagged xits; p. -Sketch 4. Elec.; Receptacles and Lighting, Distances-GFI A -9 -ed -Ft. of Occupancy , 5. Elec.; Pool Lighting; 15 volts-GFI r 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater j 8. Elec.; Grounding; Equip. w/5' -circulating Equip. -Pool Lghtg. Boxes-Enclosures-Panelboards-Ins. to Main in Conduit Card -B1 Dat - % Card -B1 Date Card -131 Date Card -131 Date 1 9. Health Department Approval G% 10. Plumb.; Cir. Test -Water Supply Test Card -131 Date Card -131 Date Card -131 Date Card -131 Date v / `'T -GT/` (.-04 &i �7 x/90 413F - s Y6 E 1 = OK o = Not - =Not Applicable RESIDENTIAL (Single and Duplex) = Not Ready ' Date UNDERFLOOR (Plans) OK except #'s 1. Zoning requirements -Setbacks -Easements 2. Ftg., Main; Soils-Steel-Elec. Grnd.-/ P' Ftg. De 3. Ftg., Garage; Soils -Steel-/ /" Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ /"Ftg. Del 5. Stemwalls, Main; Steel-Blockouts-Wrapped 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 7. Slab; Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fittings -Test -2 way C/O -Sewer Test 10. Gas Pipe; Size -Anchors 11. Water Pipe; Test -Anchors -Regulator -Service Test 12. Electric; Underground 13. Plenums & Ducts; Clearance- Material -Su pprt-Ins. 14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples 15. Insulation Card -81 Date Card -131 Date Card -131 Date Card -131 Date Date PLUMBING (Permit) OK except #'s 16. Water Ht. Vent -Access -Combustion Air 17. Water Pipe; Test & Anchors -Nail Protection 18. D.W.V.; Test-Fttngs & Anchors -Nail Protection 19. Shower Pan; Test, First Floor -Tub Access 20. Test Tub & Shower, 2nd Floor -Tub Access 21. Gas Pipe; Size & Anchors Card -B1 Date Card -131 Date Card -131 Date Card -131 Date 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/Mech. Fasteners -Bond Gas & Water 27. 2 Appliance Circuits in Kitchen & Conductor Size 28. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / /ga. Cu or Al 29. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al. Insulated Neutral Yes No 30. Service -Riser Conductors & Ground -Main Disconnect 31. Equip. Clearances Panels-Motors-Mech. Equip. 32. Clothes Closet Light -Shower Light -Spa Light Card -B1 Date Card -B1 Date Card -B1 Date Card -131 Date Date MECHANICAL (Permit) OK except #'s 33. A.C. Ducts Insulation & Support 34. Vent Fan; Exhaust above insulation 35. Condensate Drain & Overflow; Size & Grade 36. Furnace -Vent; Access -Comb. Air -Return Air Vent -115 outlet 37. Attic Access & Platform if Furnace in Attic Card -B1 Date Card -81 Date Card -B1 Date Card -131 Date Date FRAMING (Plans) OK except #'s 38. Sills, Proper Material & Anchors 39. Walls Studs -Nailing, Spacing & Bracing -Plates -Sound 40. Bearing Walls over Girders & Floor Nailing 41. Draft Stop in Walls (rat proof) 42. Fire Stops; Furred Ceilings -Stairs -Chases -Tub 43. Header & Beam -Size & Bearina Date FRAMING (Continued) 44. Hangers -Post Caps -Anchors -Connectors 45. Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng. 46. Fireplace Ties or Type A Flue -Fireplace Throat 47. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 48. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions 49. Garage Fire Protection Framing 50. Property Line Firewall & Openings 51. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits 52. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 53. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 54. Siding -Nailing Veneer 55. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 56. Glazing Area -Glass Protection -Skylights -Plastic 57. Shear Walls; Nailing -Bolts 58. Insulation-Walls-Clg. 59. Infiltration-Walls-Wndws Card -61 Date Card -131 Date Card -131 Date Card -131 Date Date FINAL (Plans) OK except #'s 60. Ext. Steps -Door & Sidelight Protection -Landings 61. Smoke Detector 62. Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor -Ducts -Meth. Protection 63. Bedroom Exiting 64. G.F.I. & Bath Fixtures & Tub Access -Spa 65. Elec. Trim & Subpanel; Breaker Sizes -Labels 66. Stairs & Rails 67. Fireplace or Stove; Clearances -Hearth 68. Elec. Outlets at Wood Panel; Int. & Ext. 69. Kit. Fixt. & Appliance; Grnd. -Air Gap -Cooking Clearance 70. Elec. Outlets & Receptacles at Kit. Counter 71. Garage Fire Door; Swing -Landing -Closer 72. A.C. Duct in Garage -Damper 73. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.- In Garage; Above Floor-Mech. Protection 74. Plb., Elec. & Mech. Equip. Listed for Location 75. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec. 76. Insulation -Foam -Looked in Attic ❑ Yes 77. Guard Rails & Deck Construction -Post Caps 78. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 79. Following instld.; Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No; Planters ❑ Yes ❑ No 80. Stucco; Brown -Finish 81. A.C. Unit; Disconnect, Electrical, Plumbing 82. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Openings. 83. Water Well; Disconnect, Electrical, Plumbing 84. Exterior Elec. Trim; G.F.I. Receptacle -Underground 85. Ventilation throughout House 86. Glass Protection 87. Corrections from Previous Inpections 88. Gas Test -Meters Tagged; Gas -Electric 89. Water & Sewer Connected -C/O to Grade -HD Approval 90. Energy Compliance Certificate -Other Certificates Card -131 Date Card -131 Date Card -131 Date Card -B1 Date Card -61 Date Card -B.1 Date Comments at Final: (NOTE: An entry must be made each time you visit iob site) MOBILEHOME INSTALLATION ACCEPTANCE COUNTY OF BUTTE y, DEPARTMENT OF PUBLIC WORKS — 7 COUNTY CENTER DRIVE .-OROVILLE, CALIFORNIA — 534-4541 PERMIT/ NO.. ^ P 7 Address or location of mobilehome Owner's names �� J -Owner's address � J :� ✓ � � /�^C1 � .�/./Ir, �/, (S' Insignia or hud number x� / -.Manufacturer's name l �i7�� s i. Serial number of V.I.N. Year of manufacture� i� i-6ial Approving Installation) (Date IF THE MOBILEHOME IS MOVED OR RELOCATED, THE MOBILEHOME INSTALLATION ACCEPTANCE SHALL BECOME INVALID. THIS FORM SHALL NOT BE USED WHEN THE `t MOBILEHOME IS INSTALLED ON A FOUNDATION SYSTEM. art 1r 513B White - Owner, Yellow - Installer, Pink - D.P.W. COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751- 7 County Center Drive, OroviIle— Phone: 538-7541' 747 Elliott Road, Paradise — Phone: 872-6307 CORRECTION NOTICE OWNER PERMIT NO. A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. Inspecto z/ �W/-*`�-/ Date-7— � COUNTY OF BUTTE ,DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2451 7 County Center Drive, OroviIle— Phone: 538-7541 747 Elliott Road, Paradise— Phone: 872-6307 CORRECTION NOTICE A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, reed additional explanation, please contact this office immediately. I� r F, zz � Inspector Date COUNTY OF BUTTE - LUEPARTMF�NT•OF PUBLIC WORKS PE T�p. 7 County Center Drive - Oroville, California 965 - Telephone: 916/538-754 APPLIOTION'AND PERMIT I ASSE R PARCEL NUMBER ��- — ZONING `� BUILDING PERMIT -OWNER Oar/ ci TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWNER' MAILING ADDRESS 1.7,01i CONTRACTOR'S NAEJW G/ TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee �8;� LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER Al C_ LICENSE NO. Plan Checking Fee $ J6520 S> Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ V PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 ` Solar or heat pump water heater 20.00 LOT NO. 02/V�mai�# SUBDIVISION NAME Z �1ACRCE/LL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF ST!UC SF ❑ DuDuplex[]Mobilehome ther SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home 0.00ea 74O TYPE OF WORK New❑ Addition❑ Remodel❑ Utilities Installation[] Other❑ Describe work: _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 � KA Main service 100 AMP OR LESS 600V OR LESS02 10.00 J Main service EA. ADD'L 100 AMP 2.50 (� CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the BuslneSS and Professions Code and my license is in full force and effect. License No. Classification ❑ 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 2/or sale. (Sec. 7044) 1, 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. DWELLING oC1: P.&! , OR ADONS. ACC. BLDGS. /20sq ft NEW CONSTR ULTI-OUTLET 2.50 ea NON.RESID BRANCH CIRC ITS (POWER APPARATUS 61 I SINGLE OUTLET CIR. Ex. Occup( OR FIXTURES 20080C 3ALO 3o Ex. -_ -_ OUTLETS FIXED P(RESID )LNS REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 O Misc. Wiring 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. shall not employ any person in any manner so as to become subject 4� 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. MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling Hood 3.00 Ventilation Permit Fee $ Contractor 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 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, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. X Date `J��a �� Signature of Applicant — Owner Contractor ❑ 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 $ Energy Inspection Fee $ TOTAL PERMIT FEE $ 'jj ocCUP. CONST.TTPE I I FLOo 1 PARCE PD HD 1397 This permit is hereby issued under sions of the Butte County. Code and/or work indicated above for which DIRECTO OF PUBLIC By P MIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date %"7.�' 7--Z—z-' Receipt No. o -r 3 WHITE-D.P.W., YELLOW-ASSE330R. PINK -INSPECTOR. GOLDENROD -APPLICANT 11 �: l/��/ ��2E �� t COUNTY OF BUTTE-DEPARTMENT.1 jP .13i:IC WORKS -BUILDING DIVISION / 7 COUNTY CENTER DRIVE - OROVILLE, GALIFORNI A 95965 - TELEPHONE: 916/534-%44541 Y PERMIT APPLICATION DATA SHEET Permit No. OWNER ✓'Oy�l//� r�l�D4Gr�/ "'�` A. P. No. 65''�/� '-Proposed Building Use 1�Building Inspector Date �f//l fl 7 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. Plans with Energy Design Compliance Statement. . . . . 6. CUSD "Fees Paid" Stamp on Floor Plan . . . . . . . . 7 Statement of Intent for Non -Heated and AC Buildings. 8. Fees of $ . . . . . . 9. Letter of signature authorizati . . . . . . . . . z0• Sanitation approval from G Health Dept. tl�12� 47 S, 11. Planning approval for (A) Use: (B) Parking: 12. Certificate of Workmen's Compensation Insurance. . . . . . 13. Contractor's License Information (no., name style, classif.) 14. Owner -Builder Verification (Given to owner[], Mail to owner ❑ ). _15. Improvements may be required. . . . . . . . . . . . 16. Mobilehome Installation Data. . . . . . . . . ' Pre-Inspec. request to (Date) 1 • Pre -Inspection for Required• Building Inspecr/ -! Recorded copy of Agricultural Acknowledgment Statement. �l6� 9. Driveway Permit. 20. Plot plan approval from city of g% 21. t 22. When you issue the ermit,'process as follows: Mail to owner, Mail to contractor: t4 elephone and hold for pickup at office, Deliver w/inspector, Other Applicant �� %''�"P— Date 7-iO " Copy of plans sent Health Dept., Fire Dept,, Other Date The following data must be submitted prio to permit issuance: (Circle new item not checked above), 1. Index permit for above items No. 2. Additional items required: t - Contractor, designer, owner, was advised of above required data by_phone---jnaiI—counter by date Contractor, designer, owner, was advised of above required data by —phone _maII—counter by date--- Plans ate Plans checked by Date Plans approved by ate Sets of plans on hold in File cabinet AP folder Copy—DPW — Hours: 10:00 a.m. - 3:00 p.m. T,O: Building Department FROM: Environmental Health S13BJECT: SANITATION CL RANCE 9499 �9AOG�l�,w OWNER Plans approved for: Hold final for: �y X36• G!'��o�� .3� YC LOCATION AP # Sewage Disposal !� Water Supple Water Supply Final Clearance O.K. for: Water Supply Clearance for bedroom mobile home. Other Clearance for addition of. { Note *zy� 1 TARIAN DATE TO: Building Department FROM: Encroachment Permit Sections RE: Driveway Clearance owner location AP # Driveway permit �3y ' has been issued for the above property. ZA signatu 7 - date RECORDED BUTTE C01111TY . OFF10A RFC4RDS Y 1881 JuL 14 Pg 12-- 31 CANDA,CE J; GRI1��S CLERK-RE-CMDER FEF-, . Return to DPW AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENT FOR RESIDENTIAL DEVELOPMENT Section 26-8.1 of the Butte County Code requires this acknowledgement be recorded prior to issuance of a building permit. The property described herein is adjacent to land. or included within an area zoned for agricultural purposes, and residents of this property may be subject to inconveniences or discomfort arising from the use of agricultural chemicals, including, but not limited to herbicides, pesticides, and fertilizers; and from the pursuit of agricultural operations including, but not limited to cultivation, plowing, spraying, pruning, and harvesting which occasionally generate dust, smoke, noise, and odor. Butte County has established agricultural zones which have as a priority use for productive agricultural purposes, and residents within said zones and on adjacent property should be prepared to accept such inconvenience or disconform from normal, necessary farm operations. All that real property situate in the County of Butte, State of California, described as follows: Date: 1—I5-617 SEE ATTACHED LEGAL DESCRIPTION PROPERTY OWNERS: BONNIE M. GOODMAN NOT COMPARED WIT, ORIGINAL DOCUMENV State of CALIF. ) On this the 13th day of July , 19 87, before ) SS. me, the undersigned Notary Public, personally appeared County of BUTTE ) BONNIE M. GOODMAN only ******************* ®�aaa®�aa�sfs®�®��asea��e�l a LeANNE GALLEGOS Hpf.4RYPUBLIC-CAUFORNIA s Butte county • My COMmisslon Expires July 13.1988 �pl��eee��ee.��e�aaaaa�a• Personally known to me. /XXXProved to me on the basis of satisfactory evidence. to be the person(s) whose names) is subscribed to the within instrument and acknowledged that she. executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Present A.P. No. AI�20 .-,,7/- �� '41AO'E 14 raG R ckcl S No a y Public LEANNE GALLEGOS I DESCRIPTION: All that certain real property situate in the County of Butte, State of California, described as follows: Lot 102, as shown on that certain Map entitled, "PARADISE PINES MOBILE HOME ESTATES UNIT NO. 1", which Map was filed in the Office of the Recorder of the County of Butte, State of California, on April 10, 1970, in Book 35 of Maps, at Pages 65, 66, 67 and 68. i� EXCEPTING THEREFROM all of the valuable minerals beneath the surface of said lands, with right to mine and extract said minerals, it being agreed and understood that in all mining operations, the surface of said lands will be protected against damage and that all such mining shall be carried on from tunnels, shafts or drifts having their orifices outside of the surface'areaof the above described realty, all as excepted and reserved in the Deed from Magalia Mining Company, a corporation, to E. D. Storts, et ux, recorded September 4, 1947, in Book 423, Page 385, Official Records. T ELECTRIC GAS Support Struc. Compaction. Test Re . iervice Other Pipe YESI NO YES. NO iizeLoad Type Size Len th -7 sem- wyle 0 '1 / y Y ( - COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 5 ZONING BUILDING PERMIT OW R TVEJLryEPHONE SO. FT. OCC. BUILDING VALUATION OWNE S MAIL( G ADDRESS u/Lit CONTRACT 'SN ME `' d TELEPHONE CONTRACTOR'S MA LING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee 10.00 LEN'S MAILING ADDRESS 'S Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ V Energy Plan Checking Fee $ AR CHI T' CT E'NGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME L ` PARCEL MAP Water piping 5.00 Each pas water heater or vent 5.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G 10.00 ea TYPE OF WORK New ❑ Addition model ❑ Utilities ❑ Installation Other ❑ Describe work' Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 8001 OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (Check.One): ❑ I 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. Classification ❑ 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) 21/1, 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. DWELLING OCCUP.q OR ADDNS. ACC. BLOGS. 2,h2sq ft NEW CONSTR ULTI.OUTLET 2.50 ea NON-RESID BRANCH CIRCUITS) (POWER APPARATUS R1 (SINGLE OUTLET CIR. I ( 0050t - Ex. Occup\OUTLETS OR FIXTURES 2AL@30 eALeso \\ Ex. Occup. OUTLETS FIXED P(RESID )LNS REA./ 1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 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. Q ' 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. MECHANICAL PERMIT FiIingFee 10.00 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. 1 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 against said County in consequence of the granting of this permit. p� �i� X ' / ��'' Date — /O Y� Signature of Applicant — Owner [ * Contractor❑ Agent❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct -EC ion of structures over 3 stories in height. Mobile Home Installation Fee $ p Energy Inspection Fee $ TOTAL PERMIT FEE $ (� OCCUP, CONST.TYPC I I aLgo9 (,� PARCEL PD HD 59U TNrmitereby issued under ste County" Code and/or wabov tfor which OR OF PUBLIC B PER IT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date A y7 �+ Receipt No. X,,Z� 3 WHITE-D.P.W.. YELLOW-ASSE930R, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF'PUBLIC WORKS - BUILDING DI,V1 IS O;N -' 7 COUNTY CENTER DRIVE - OROVILLE, QALIFAR41A_ 5965 - TELEPHONE: 916/534-4541 PERMIT APPLICATION DATA SHEET--'` Permit No. OWNER ✓U'.��(//� ►jae; !?.t /Al A. P. No. Proposed Building Use ��/ 1,rJT�� Building Inspector7A*Dgl Date 7-- 6�- 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. _Plans with Energy Design Compliance Statement. . . . . . 6. CUSD "Fees Paid" Stamp on Floor Plan 7 Statement of Intent for Non -Heated and AC Buildings. 8. Fees of $ . . . . . . , 9. Letter of signature authorization. . . . . . . . . . . 10. Sanitation approval from Health Dept. . . 11. Planning approval for (A) Use: (B) Parking: 12. Certificate of Workmen's Compensation Insurance. . . . . . ' 13. Contractor's License Information (no., name style, classif.) 14. Owner -Builder Verification (Given to owner❑, Mail to owner ❑ ), _15. Improvements may be required. . . . . . . . . . . . 16. Mobilehome Installation Data. .. . . . . . . . . Pre-Inspec. request to 17. Pre -Inspection for Required- (Date) p q Building in 18. Recorded copy of Agricultural Acknowledgment Statement. { 19. Driveway Permit. _,Plot plan approval from city of r 22. l Wheou issue the permit, process as follows: o Mail to contractor. • Telephone and hold for picl a off e, Deliver w/inspector,. Other. he Cq K Applicant d��- �� iaDate"'0 Copy of plans sent Health Dept., Fire Dept., Other Date The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: AW Contractor, designer, owner, was advised of above required data by—phone---Mai I counter by date Contractor, designer, owner, was advised of above required data by—phone —mal l—counter by date Plans checked by Date Plans approved by �� Date -1 Sets of plans on hold in File cabinet AP folder — Flours: 10:00 a.m. - 3:00 p.m. Copy—DPW 200' -- 140' This set -of plans and -specifications MUST_ ::b� kept on the job 4�all.ticnes.and. it is unlawful to Maany cwmi r. alterations.on same without writtenpermission mm the Department of Public,_- Wks,-County..afutte. R /D 'Pus- 120' PuF 120' A 100' r' 80' 60' NCiTEti--AI) . Mateials.--1Norkmanship Accordance ' with - Recognized " Good Pr Of a quality prescribed for the Sppecifies Unifo"W luilding,--Plumbing & Macl qcp' cal 4w NafiorW, Bear W .Com 20t -_�—�- 40' 60' Utility connections shall be within 4 ft, of the mobilehome, either - _' directly behind or within thereat' half j of the mobilehome. lA permit -will be riquir*d for ft bodemm ,of fhe M6, bifehonr 500:SQ: FT: MINIMUM FOR: MOBILES qsefbaiek of 5 Tt.:from the .:.:___.._... �. Property lines and a setback �. of 50ft.from the road centerline shall be clear of - structures or equipment except Shall 11► : n�. a 7 ft: e"I"a AVor�drl AWG me:4 t ape-M......�..._ notices :and ' - use ift'. the Ccs (�0 . SUILDING DEPARTMENt -APPROVED` Zz94��7 Af LLT _ 80' 100' 120' 140' 160' od 12WNs 2ndi'r�5i �� t�z u7sG .ro1C( �0 tet Z10T Of ;i:��.i�Sr1.t 2i #i �lnn z�r't,;t iity 'Ll t: no iron ?'i��arli't1v ::Pti�2 ,'�«!«Oefr�l_'1fU '1A a:�rtr�:t� 1!t,1k Sritrtt•1'o aiid'�t�? }o nsn�i�vc�aCi ;ori# rno �r rtrsgxxins� r,�t4i1w rif, w C6 i!E::�i' ZisG+tJ:ff��0] Yi+IitU 0r i'?`sv 11 hr�±tt�d yiEtr�t;a }p 1116A sm Imi blliup—)i .?3 +ice iis�°" tCi MU;.tlMi A .91 V 03; &OF" wPA 9101 raG(";i i() 1S�i� JCS liefi; :srtil'l3ffia t{i9^YEt #ft�f fCtU�J`: 10 sr11)F�U1i2 �, , , c�.•� ., ter; I�.��' o3 0 1 A ONE r a� tltir#� �ir�2r►►.��"+,�?rnW � z�37i+�fsa'� i�f0---':�ZiJy': 1+9'nars��S53 sitirnt+,cnan• rot k.i! :1`.3ltt�!? 4 n4�'� "•��' �1�9Q1YJi^,t�� i l�f?(1 r }�' np II{ !fl�'siltr �7�Z n; rMP fwti .44 Abo"I lbzilbA lomoi4;;)w , BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA PHONE: 534-4541 MOBILEHOME INSTALLATION SHEET 1. Owner's Name: A)A=2 /• G M A-1 2. Installer's Name: 3. Is the site currently under permit? Yes E? No F] _ (If yes, furnish permit number ?/l/ ;-'6 % ) OR Is the site an existing site? Yes No (If yes, furnish two 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? --------------- i Amps 6. What is the mobilehome site service rating? ------------ ^700 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 El No El (If yes, identify the load and size: (Load) (Amps) 9. What is the mobilehome site gas pipe size? -------------- AV (in.) type g ? ------------------- 10. What is the t e of as service. � Natural- LPG 11. What is the gas pipe length from meter or tank to the mobilehome? --------------------------------- o- . * 12. What is the mobilehome gas demand? ---------------------- (BTU) •*(This"'information not required if pipe length less than 6 ft. on na:tural,tgas or less than 50 ft. on LPG.) MOBILEHOME SUPPORT DATA If,other than single wide, Mobilehome Mfr. 0 Ole IJP. furnish Setup Model No. Year Width (ft.) Box Length G! ® (ft.) Tagalong or Expando Size '~" ft: x —0*" ft. 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). FOOTINGS (check one)® 1. Wood -pressure treated or foundation grade.. a 2. Other (specify) SUPPORTS (check one) RA Concrete block.a 2. Other (specify) Pier Footing Sizes and Locations SINGLE -WIDE MULTI -WIDE Line I Piers: Size -Min- ------------ ,k Spacing -Max- --------- From Ends -Max ---------- Line 2 Piers: Size -Min .------------ Spacing -Max---------- ,- From Ends -Max .------- Line 3 Roof Loads: Size -Min.------ ----� Location (From Front) Line 4 Piers: Size -Min ------------- Spacing-Max ----------- From ------------Spacing-Max---------- From Ends -Max -------- Line 5 Roof loads: Size -Min. ------------ Location (From Front) Line 1 Openings: Size -Min- ------------------ ux u Each Side of Openings With Width Over --------- Line 3 Piers: (Under Bearing Wall Only) Size -Min ------------------- ix n Spacing -Max .--------------- �_ u From Ends -Max-------------- .,x .x ,k e 5 Piers: '(Under Bearing Walls only)_ + Size-Min------------------- i� it Spacing -Max---------------- From Ends -Max.------------- i�S=YIJ4 =`A_1�iN1=i.1_ COUNTY 7bou9'ycenR.rv% ,,y tPARTMENTt0177.: PUBLIC WORKS,i 44 Callfomla 5965'.ijelElplione. 9116/638455411--t't 1,0i AND *,"P, ki if " PERMIT NO. ASSESSOR,RIARCEL NUMBER is 7 ZONING"' 065-310-046 e *,"BUILDING' MIT OER- O&TELEPHONE M� V�, �-V MIE GOODMAN M _ te� 187 SQ;. FT., OCC. .BUILDINGVALLIATION C 1,560 OWNWR*S MAILING ADDRESS P.O. BOX 1719 PARADISE CONTRACTOR'S NAME _tl_ 0 .TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWNTotal Valuation $ 1,560 Filing Fee $ 15.00 LENDER'S MAILING ADDRESS Permit Fee $ 31.50 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ 20.00 Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ - BUILDING ADDRESS 14836 GOLDCONE MAGALTA 95954 Permit fee $ '66.50 PLUMBING PERMIT Filing Fee 15.00 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO.SUBDIVISION NAME 102PPMHE #1 PARCEL MAP Water piping 7.00 Each vas water heater or vent 7.001 USE OF STRUCTURE SF❑ Duplex❑ MobilehomeF-1 Other CARPORT 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 New FX Addition E] Remodel [] Uti lities ❑ Installation[] Other ❑ Describe work: Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 600v OR LESS 200A OR LESS 18.50 Main service 200A TO 11000A) 37.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): F❑_1 I 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. Classification Iry 1, as the owner, or my employees with wages as their sole compen- LZ31 sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) 0 1, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) f-1 I am exempt under Sec. Business and Professions Code for this reason NEW CONST DWELLING OCCUP.&) OR ADONS.' ( ACC. BLDGS. �) $3.54 sq.ft.1 NEW CONSTR. ULT"OUTLET NON-RESID. BRANCH CIRCUITS) @ 5.00 (POWER APPARATUS& SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURE S 20 @ 75d AJ (@ 464 FIXED APPLNS. oR Ex. Occup. OUTLETS (RESM I EA 3.00. Temporary service 1 15.001 Mobile Home Facilities 15.00 Misc. Wiring *15.00 I Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. Ej 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. rN-?- I shall not employ any person in any manner so as to become subject 40k to the W. C. laws of California. Notice to Applicant: If after making this statement, should youbecomesubject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling Hood 6.501 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 ot 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, judgment- costs, and expenses which may in any way accrue sa Coun co sequence pf the granting,of this permit.. n- TO Date 2 Signature of Aq�lint_ Owner El Contractor 11 Agent lqv Pk 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 Energy Inspection Fee $ OCC CONST TYPE TOTAL FEE $- 66-50 HAZ 0 FEES I IMP I FLOOD I COF PARCEL I PO I HD ISSUE This permit is hereby issued under the sions of the Butte County Code and/or . . work indicated above for which fees DIRECTOR OF PUBLIC:WORKS, I By PERMIT EXPIRES Date applicable provi resolutions to do have been paid. Date Receipt No. 12- -L 46 21— A WHITC-C.P.W.. Y9LLOW-A3SE3SOR. PINK -INSPECTOR. GOLDENROD-APPL I CANT