HomeMy WebLinkAbout065-330-051Rodger' AP 65-33-51 �� w
_ r Piercy y� � /
5 Holmwood; Magalia / "y?/a$ /
Permit 3406-77E (upgrade ex. elec./MH)
., SAP 6565-33--51
Permit 4032-77B
CONTR: Sierra Mo bi e Supply, Paradise
. (awning/MH)
065-330-051 02-293�(1 &Ep
JOHNSON, MARIE
14721 HOLMWOOD, MAGALIA
C/O ELECTRICAL SERVICE PA
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02-2936
065-:330-051
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JOHNSON, MARIE
14721 H06MWOOD
, MAGALIA
C/o ELECTRICAL SERVICE PA
NEL
-------------
OFFICE COPY
Address
GAS
Meter By Date
ELECTRIC
4
Meter By Date
�
AN
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
5. ; 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 -9► No•%
(Rev. 12/96) APPLICATION AND PERMIT �►'-�09
ASSESSOR PARCEL NUMBER
065-330-05
ZONING
BUILDING PERMIT
OWNER��/'���1��ryry����
.ML ISM
TELEPNONE
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS -
30 N. GOBI CIRCIY,. SPARKS
CONTRACTOR'S NAME
TELEPHONE
CONTRACTORS MAILING ADDRESS'
CONSTRUCTION LENDER
Fireplace
LENDER'S MAIUNG ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 2 0.0 0
Permit Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDINGADDRESS
Energy Plan Checking Fee
$
$
PERMIT FEE
$
LAT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
Each Trap
7.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other !
SPECIFY
Solar or heat pump water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: C/0 ELEMIC,AL SF'RVTt:I PANE,
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home I S I G I W
@20.00
PERMIT FEE
$
ELECTRICAL PERMIT
Fling Fee 20.00
a00V OR LESS
Main Service 200A OR LESS
23.00 23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.PSINGLE
License Class LIC. No.
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
`❑I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this per"mit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
Main Service zooA TO 1000A
46.00
NEw CONST. DWELLING OCCUP.
ORACC-ou�rLS.
ADC�� (
3 5QS0.
FT
M ET
NONRESID.
@7.50
8 OUTLET OWER APPARATUCIR.S
Ex. Occu OUTLET OR FIXTURES
�� @''
.50
FIXED APPLNs. OR
Ex. Occup. OUTLETS RESID. EA
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wirin
23.00
__F23-00
PRE -INSPECTION
PERMIT FEE
S 66.00
MECHANICAL PERMIT
Fling Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEE
$
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions..
X J 7 : Date y� • _
Signature of Applicant - ❑ Owner ❑ Contractor IVAgent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee
$
Energy Inspection Fee $
occ
CONST. TYPE TOTAL FEE $ 66.00
HAZ.
D. FEE�, IMP
✓ ,.,r
FLOOD
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CDF
._
PARCEL
...._
PD
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HD
ISS
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.
By I % DateG (V, I
PERMIT EXPIRES ON 10, 2 1 . ` ;
Date
I
�r"�
Receipt No. t) (0 � 6 V M'
WHITE-D.D.S.-B.D. CANARY -ASS SSOR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVIS
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-75
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBM
065-330-05
ZONING
BUIL61NGPERMIT
OWNER JOHNSON..
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
.OWNERS MAILING ADDRESS
30 N. GOBI CIRCLE, SPAIRKS, �V
CONTRACTOR'S NAME
TELEPHONE
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 20.00
Permit Fee
$
ARCHITECT OR ENGINEER I� MAIUNG ADDRESS
Plan Checking Fee
$
BUILDING ADDRESS
14721 1
Energy Plan Checking Fee
$
$
PERMIT FEE
S
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other
SPECIFY
Each Trap
7.00
Solar or heat pump water heater
23.00
Water piping
15.00
Each as water heater or vent
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: C/O ELE IC'AL SERVICE PA -DO
Gas piping stem 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home IS I GI W1
920.00
PERMIT FEE
S
ELECTRICAL PERMIT
Filing Fee 20.00
Main Service 2o0A OR IESS
23.00 23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing wRh Section 7000) of Division 3 of the Business and Professions Code,
and my license is n full force and effect.
License Class Lic. No.
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the followiig reason:
❑ I, as owner of the property, or my employees with wages as their sole compensation,
ill do the work, and the structure is not intended or offered for sale.
as owner of the property, am exclusively contracting with licensed contractors
construc: the project.
�'il
am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by Section
3700 of the :.abor Code, for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
wo rscompensation provisions of section 3700 of the Labor Code, I shall
f h ith co ply with thos rovisions.
l y(�
X Date �' T Z
Signature of Applicant - ❑ Owner 11 Contractor Yi Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Main Service 200A TO 1000A
46.00
NEW CONST. DWELLING OCCUP.
OR ADONS. a ACC. BMS.
SO
3.50FT,
µR°�I.T' MULTBRANCI-OUTLET @7,50
OWER APPARATUS
8 PSINLE GOIJr. CIR.
Ex. Occup. OUTLET OR FIXTURESBA� @': 0
Ex. Occup. oFur�is-RFS ) E 5.00
Temporary Service
23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PRE—INSPECTION23-00❑
PERMIT FEE $ 66,00
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEE $
Mobile Home Installation Fee $
Energy Inspection Fee is
Occ
CONST. TYPE
TOTAL FEE $ 66.00
HAZ.
D. FE IMP
I FLOOD
I COF
PARCEL
PO
HD
ISS
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.
By ij'V Date I Q Z� O
a
PERMIT EXPIRES ON 10,229. . 0-3
Date
Receipt NO.
WHITE-D.D.S.-B.D. CANARY -ASS SSOR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE -DEPARTMENT OF"DEVELOPMENT SERVICES-BUILDINGf (VISION
' 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)5318-2140PERMIT APPLICATION DATA SHEET
OWNER: �"" ' M�n �e_ ASSESSOR PARCEL NUMBER 33 O P 05---
Proposed Building Use: e " ' ' �' J�Y `"'�- Counter Technician: t ' Date: ' SL/ 0�
Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply.
❑ 1.. Plot plans, 3 or 4 sets, signed by the preparer of the plans.
❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans.
❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ 4. Engineered truss details and layouts in duplicate. No faxes! "*---
0
*- - —❑ 5. Energy compliance design and supporting documentation in duplicate.
❑ 6. Manufactured homes: (A) Data sheets and installation instructions, (B) Marriage line information, (C) Floor Plan, (D) Tie down or
foundation plans, all in duplicate.
❑ 7.1 Metal buildings: (A) Metal Building Plans, (B) Foundation plans and calculations in triplicate, (C) Elevation views in triplicate.
(D) Floor plans in triplicate. All of these must be stamped and wet -signed b the he engineer.
Items required for initial plan review. If checked items have not been received, plan review cannot proceed. The permit will be
indexed and returned to the plan review line-up when required items are received.
Date Received By
❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate ................................
❑ 9. Plot plan and business license approval from the City of Biggs ....................................
❑ 10. Letter of intent for non-residential buildings.........................................................
❑ 11. Detached Accessory Building Form filled out by the owner .....................................
❑ 12. Hazardous Material Form...............................................................................
❑ 13. Other
Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
❑ 14. Fees as shown on the attached Schedule of Fees Due Sheet .......................................
❑ 15. Statement of Intent for Non -heated and A/C Buildings .............................................
❑ 16. Sanitation and plot plan approval from the Environmental Health Department in
❑ 17. City of Chico Plumbing permit.........................................................................
❑ 18. California Department of Forestry plan approval ❑ paid. Sent by: ......................
❑ 19. Planning approval for (A) Use: (B)Parking: (C) Parcel Check:
❑ 20. Contact Land Development about ❑ Improvements, ❑ Drainage ...............................
❑ 2 Encroachment Permit for ivew, y om the ublic`Works Dept. (construction approval prior to occupancy).
CY 22. Pre -Inspection for e< C' I �rC— �C ��`� t C-2 equired................
❑ 23. Contractor's license information. (Number, Name Style, Classification) ......................
❑ 24. Worker's Compensation Carrier and Policy Number ..............:..............................
❑ 25. Owner -Builder Verification (❑ Given to owner, 0 Mailed to owner)......................
❑ 26. Letter of Signature authorization.....................t..............................................
❑ 27. Recorded copy of Agricultural Acknowledgment Statement..... .................................
❑ 28. Manufactured home utility clearance...............................................................
❑ 29. Existing violations and/or expired permits.........................................................
MI.. ❑Grant D91e�d, [�.7�I�I., Titl V rW- e&7 Facts, Lettorr� Legal Owner, ❑ Check�rorH.C.D. $
Other: C: Q t""t.�j- eT►�/� � OWrter �f- VY► lLI'� �
When issued T
and hold for pickup.
I have been infornried the above items and requirements for obtaining a building permit. 10-et/0 Applicant: Date:�e L
1. Index permit application for the above items numbered:
2. Additional items required
Contractor, designer, owner, was advised of the above data by
Contractor, designer, owner, was advised of the above data by
Plans reviewed by: Date:
Structural reviewed by: Date:
Note transfer by: Date:
Yellow: Building Division
phone, ❑ mail, ❑ counter, by
phone, ❑ mail, ❑ counter, by
Plans approved by:
_Structural approved by:
.—rc--
Plan Check Letter
_Date: _
Date:
Date:
Date:
�C
OWNER:
PRE -INSPECTION REPORT
Uyl t 146r,,c
PRE-24SPEITON FOR Semi/ t� 2 ��- I
DATE: O - Z+ 0-;�--
A.P. # 'O(0'3- 3� - 051
ZONING:
DATE TO INSPECTOR (0� %� PXRM =rORY.j ) NONE ( FOLLOWS:
BUU.. MG INSPECTOR'S REPORT
BuOdInF Daeelpdm
CUM* Ooewied A,
AbandonedMacant
V
Electric: � •s
Yes No Electric currently On Off
,
Condition of Electric '
Gas: /
Natural Propaae J None Curren On /Off
Obvious Problems:
Sanitation:
Plumbing Working
Well Working Potable Water *,j
Obvious Sewagemblems
` E
Comments: \
ACTION RECOMMENDED: ISSUE: 1 y HOLD FOR
Inspector:_ Date
Sketch buildings on reverse and'indicate location on property.
t 3
�.�. =• 4032-77B ---�.
PERMIT N0.
.� PERMIT EXPIRES
OWNER RODGER PIERCY
CONTR. Sier'r'a Mobile Supply
LOCATION (A.P. 65-33-51 )
5 Holmwood, Magalia
f
(
• j
-Temp. Power Pole
Called PG&E
Temp. Elec. Serv.
I Called PG&E
! Temp. Gas Serv.
b
Called PG&E
JOB 11 ll
FINALED
(Date)
(Signature
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION RECORD
40ILDING BUILDING (Cont'd) PLUMBING
Setback
Firewall
Soil Piping
Forms
Parapets
1st Floor
Main Bldg.
Restroom Finish
2nd Floor
Footings
Windows
3rd Floor
StemwalI
Sidin
To out
• Slab
Roof Sheathing
Water Piping
Piers
Roofing
Sewer
Garage
Fdn. Vents
Fixtures
Footings
Stemwa I I
Garage Vents
Insulation
Water Htr.
Heaters
Slab
Carport
p
Footings
Prov. for physically
handica ed
Conformance of ex.
structure
Appliances
Gas Piping &Test
Temp. Gas
Slab
Final !2`%
Sanitation
Patio
FIREPI-4761i
Final
Footings
Footing
ELECTRICAL
Masonry Walls
Throat
Rou h
Relnf. Steel
Final
Fixtures
Bond Beam
FIRE SPRINKLERS
Motors
olucco
renal
Subpanels
Mesh
MECHANICAL
Grd. Fault Prot.
Scratch
Heating
Service
Brown
Cooling
Temp. Pole
Finish
Ducts
Underground
Interior Lath
Ventilation
Permanent
Door Closer
Final
Final X — 7- '7 7-
MOBILEHOMEUTILITIES------------------
Elec. Service
Elec. Pedestal
Water Piping
Sewer
Gas Piping
MR816EMOME INSTALLATION - - - - - - - - - - - - - - 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.)
4
COUNTY OF UUTTE — DEPARTMENT OF PUBLIC WORKS
v• 7 County Center Druce — 'U1'oviIIe, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
IZI_03a- 7 7
/YI% �
authorize representatives of the County of Butte to enter upon the
above -me ned roperty for in ec on purposes.
X
c
Date a ��
Signature of Permiteeee or Agent
Receipt No. 17 �p 79
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.
DIR R`OF BLIC WORKS
By Date 7
Building permit expires Date tri —A;z —, 0-
�
BUILDING
Owner
SQ. FT. OCC. BUILDING VALUATION
Mailing Address
Telephone No.
Fireplace
Contractor �1i�/� I1f Sv,P?/�
Total Valuation
Mailing Addres 6�" S�C
Permit Fee
Plan Checking Fee &/or Penalty
®. J/
�i
Te eph7- 1070
7 G
Permit Fee $
Building Address
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00
Each Trap 1.50
Z COO'—
Repair drainage or vent piping 1.50
Water piping 1.50
Each gas water heater or vent 1.50
A. P. No.
Zoning & Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
F s_ffi
a Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA Parking Parcel
P��lans�/'' Declaration
Parcel Ma P
60' R/W
Im rovements
P
Lawn sprinkler system 2,00
Bldg. Plarivliec'd I
Parcel royal
Pla s Approval
Permit Fee $
$
NEW ADDITION ❑ UTILITIES ❑ OTHER ❑
ELECTRICAL No. @ FEE
PERMIT FILING FEE J$3.00
Main service 600v OR LESS 5.00
100 AMP OR LESS
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. AOD'L 100 AMP 1.00
NEW CONS. DWELING OR ADDNST ( ACCLBLOGS.CCUP. &) 20 sq ft
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
style of: �� /� 'Ger;l�
!2Z�[ �C
Ex. Occup(OUTLETS OR FIXTURES) BAL@109
FIXED APPLNS. OR
Ex. Occup.(OUTLETS (RESID,) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
O�
License No. a 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 Workmen's Compensation.
I have placed on file with the County of Butte a certificate of
+ Workmen's Compensation Insurance.
1 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 $
$
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
$
authorize representatives of the County of Butte to enter upon the
above -me ned roperty for in ec on purposes.
X
c
Date a ��
Signature of Permiteeee or Agent
Receipt No. 17 �p 79
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.
DIR R`OF BLIC WORKS
By Date 7
Building permit expires Date tri —A;z —, 0-
�
COUNTY OF BUTTE-. — DEPARTMENT OF PUBLIC WORKS
7 County Center DrWe • `OroviIIe, California 95965 SV�a-7�'
Telephone: 534-4541 �
APPLICATION AND PERMIT
•
BUILDING
Owner��, �� +�
SQ. FT. OCC. BUILDING VALUATION
Mailing Address 0,
1—�-
Tr '7 phone
Fireplace
Contractor
Total Valuation
Mai I i ng Address
Permit Fee
Plan Checking Fee &/or Penalty
Telephone No.
Permit Fee $
Building Address � t, PK W 00 IQ
PLUMBING No. @ -FEE
PERMIT FILING FEE $3.00
W S • *JQL, 090, 11200 f / Ss 60.
Each Trap 1.50
Repair drainage or vent piping 1.50
Water piping 1.50
4 ALf
Each gas water heater or vent 1.50
A. P. No. I ,
Zoning & Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
Few
*1. C. -Sanitation
Fire Dept.
FireZone
Use Permit
Building sewer 5.00
EQA
Parking
Plans
I Parcel
Declaration
Parcel Ma P
60' R/W
Imp rovements
P
Lawn sprinkler system 2.00
B ans ec'd I
Parcel Approval I
Plans Approval
Permit Fee $
$
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00.2-
•
•
Main service 6000 OR LESS 5.00 —
100 AMP OR LESS
Main service EA. ADD'L 100 AMP 2.50
Single Family ❑ Duplex ❑ Mobil Home Others ❑
Main service OVER s O 25.00
100 AMP OR LESS
Main service EA. ADD'L 100 AMP 1.00
NEW OR A.D.S. ( ACCLBLDGS.CCUP. &) 2¢sgft
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
style of:
Ex. Occup(OUTLETS OR FIXTURES) 50 BA@�
FIXED APLNS
Ex. Occup. ( OUTLETS PIRESID,)REA) 2.00
A,5,700
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 Cal ifomia.
Permit Fee 0 —
$ r
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.
ElI 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
i=ce) 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
+2.00.
Hood
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
$02� ^
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
e
Date 7A177
Sign re of Permitee or Agent
Receipt No. IO /
White-D.P.W'.-Yell !$y�-Pink-Insp 4-&bQJProd-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 OtPIJBLIC WORKS
By Date 7- 2--o— 7 1
? �—�$
ding permit expires Date