HomeMy WebLinkAbout065-350-04465-35-44
Antonio Zaragoza
1235 olmwood Dr., lot 103, SDO#2,Mag
contr: !radise Modular Coneepts,Para
Permit #4 4A-80P,wutil i)
ELEC . q Z* w-"?c0Iq ��'4
GAS -7 IYa
SUPPORT STRUGURE RE
COMPACTION TEST
65-35-44#14f I
contr: radise Modula?fConcetps,Para
Per 't #4442-80AI
ssued qj —,���Q
65-35=44
contr: Sierra obte Serv., Paradise
Perini r��5'` 0-808 n w de�/���i
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FAR RVAI
L PERMIT NO. 4441-80P,E _
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PERMIT EXPIRES jQ 1,V(
OWNER Antonin Raragn7a
Paradise Modular Concepts, Paradise
CONTR.
.'� 65-35-44
ASSESSOR PARCEL
LOCATION 1235 Holmwood Dr., lot 103;
SDO} 2, Maga 1; a
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c,7s
Ll C
Jl'r
,SSI
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3
+3 Temp. Power Pole
Called PG&E
• � Elec. Servic
/Os>e
Called PG& za —� Z4 z
Te Gas Se vice
l Call
`tiff
JOB FINALED (Date) A
Signature
J = OK
O = Not OK
- = Not Applicable RESIDENTIAL (Single and Duplex)
* = Not Ready ,
Date
UNDERFLOOR Plans OK except #'s
Date
FRAMING (Continued)
1. Zoning requirements -Setbacks -Easements
48.
Property Line Firewall & Openings
2.
Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth
49.
Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
3.
Ftg., Garage; Soils -Steel- / /" Ftg. Depth
50.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
4. Ftg., Porches & Decks; Soils -Steel- / /" Fig. Depth
5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab
51.
52.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
Siding -Nailing -Veneer
6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab
53.
Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access
7.
Piers -Fireplace Ftg.-Steel
54.
Glazing Area -Glass Protection -Skylights -Plastic
8.
D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test
55.
Shear Walls; Nailing -Bolts
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- c Bolts -Joists -Vents -Cripples
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Dat Card -BI Date
Card -BI
Date Card-BN,Date
Date
FINAL
(Plans) OK except N's
Card -BI Date Card -BI Date
Date
PLUMBING (Permit) OK except #'s7
6.
Ext. Steps -Door & Sidelight Protection -Landings
Smoke Smoke Detector
14.
Water Ht.; Vent -Access -Combustion Air
58.
59.
Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
Bedroom Exiting
_
15. Water Pipe; Test & Anchors -Nail Protection
16. D.W.V.; Test-Fttngs &Anchors -Nail Protectio
17.
Shower Pan; Test, First Floor -Tub Access
60.
G.F.I. &Bath Fixtures &Tub Access
18.
Test Tub & Shower, 2nd Floor -Tub Access
61.
Elec. Trim & Subpanel; Breaker Sizes -Labels
19.
Gas Pipe; Size & Anchors
62.
Stairs & Rails
63.
Fireplace or Stove; Clearances -Hearth
64.
Elec. Outlets at Wood Panel; Int. & Ext.
Card -BI
Date Card -BI Date
65.
Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
Card -BI
Date Card -BI Date
66.
Elec. Outlets & Receptacles at Kit. Counter
Date
ELECTRICAL Permit OK except p's
67.
Garage Fire Door; Swing -Landing -Closer
68.
A.C. Duct in Garage -Damper
20.
Fixture & Transformer Clearance -Ins. P otection
69.
Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor-Mech. Protection
21.
Elec. Receptacles Spacing -Lights & witches at Doors
70.
Plb., Elec. & Mech. Equip. Listed for Location
22.
Size Boxes & No. of Conductors -S pled
7
Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
23.
Romex Installed Close to Edge eStuds & C.J.
72.
ulation-Foam-Looked in Attic ❑Yes
24.
Equip. Ground made up w/MeqK. Fasteners -Bond Gas & Water
73.
Gua Rails & Deck Construction -Post Caps
25.
2 Appliance Circuits in Kit en & Conductor Size
74.
Fdn. Ve s & Crawl Hole Door -Drainage & Wood -Earth Clearance
Looked un Floor ❑ Yes
26. Subfeed Wire Size / / 96. Cu or AI-A.C. Wire Size / / ga. Cu or At
27.
Range Circ. / / ga. u or AI -Oven Circ. / / ga. Cu or Al,
Insulated Neutral es E:) No
75.
Following inst .: Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No;
Planters 0Y0N
28.
Service -Riser Co uctors & Ground -Main Disconnect
76.
Stucco; Brown -Finis
29.
Equip. Clearanc ; Panels-Motors-Mech. Equip.
77.
A.C. Unit; Disconnect- nces-Brkr. & Cond. Size -115V Outlet
30.
Clothes Close/Light-Shower Light
78.
Vents Above Roof; Plbg.-A liance-Firepl.-Clearance to Opngs.
Card B-ICard-B
Card B -I
Dat
D e _ I Date
CaI rd-BDate
79.
Water Well; Disconnect, Electri I, Plumbing
80.
Exterior Elec. Trim; G.F.I. Recept le -Underground
81.
Ventilation throughout House
82.
Glass Protection
Date
MEC ANICAL (Permit) OK except N's
83.
_
Corrections from Previous Inspections
84.
Gas Test -Meters Tagged; Gas -Electric
/a�r_d-Bl
Card -BI
A.C. Ducts; Insulation & Support
Vent Fan; Exhaust above Insulation
Condensate Drain & Overflow; Size & Grade
Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet
Attic Access & Platform if Furnace in Attic
Date Card -BI -_ Date
Date Card -BI Date
85.
Water & Sewer Connected -C/O to Grade -HD Appro 1
86•
Energy Compliance Certificate -Other Certificates
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date _
Card -BI
Date Card -BI Date
Date
FRAMING(Plans) OK except p's
3_6. Sills; Proper Material & Anchors _
37. Walls: Studs -Nailing, Spacing &_Bracing-Pla_t_e_s_-Sound
38. Bearing Walls over Girders & Floor _Nailing_ _
39. Draft Slop in Walls (rat proof)
40. Fire Stops; Furred Ceilings -Stairs -Chases -Tub
Comments at Final:
_
41.
42.
43.
44.
45.
46.
47.
Header & Beam -Size & Bearing _
Hangers -Post Caps -Anchors -Connectors
Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng.
Fireplace Ties or Type A Flue -Fireplace Throat
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
Bdrm. Windows or Exiting Doors -Sill Hqt. & Dimensions
Garage Fire Protection Framing
_
i!%6- (NOTE: An entry must be made each time you visit job site)
V = OK
O = Not OK
- = Not Applicable
= Not Ready
MOBILEHOMES
MISCELLANEOUS
Date
MOBlLEHOME UTILITIES (Plans) OK except N's
Date
DECKS, COVERS, CARPORTS, ETC. (Plans) OK ex6pt N's
Zoning Requirements -Setbacks -Easements
1. Zonin4 Requirements -Setbacks -Easements
Soils; Special MH Support -Sketch
2. Footin ; Size -Depth -Spacing -Connect
ewer; Location -Test -Fall -C/ Co
3. Decks; ' ders and/or Joists-Deckin Bracing -Stairs -Rails
-
r; Location -Test -Easement Needed (Sketch)
4. Wood Awn.; osts-Beams-Rftrs.- nnec.-Shthg.-Rfg.-Bracing
J
Electricity; Low-Cleaj'2 ces- -/Ai 0/ Amp -C -mw ate
_
5. Alum. Awn.; lumps-Connectio s -Splice -Decal -Enclosures
6. G , ,ocatio est Wrap:/ /"L"ft./ /"Nat.or/ /"L"ft. /"LPG
6. Carports; Window- oors
L�
Utility Clearance
7. Elec.
Card -BI
Date Card - BI Date
Card -BI
Date ar I Date
Card -BI
Date i o Card -BI Date
Card -BI
Date Card- Date
Date
MOBILEHOME INSTALLATION (Plans) OK except #'s_r?-' - /()
Date
POOLS (Plans) OK exc pt #'so
ing Requirements -Setbacks -Easements
1. Setbacks-Easem nts
tings; Size -Spacing -Marriage Line
2. Soils; Compact' n -Structure Stabilit
Gas st Demand-Vabc&-Conrtea6r
3. Pool Structur ; Steel -Connections -Thi kness-Dead Men -Lining
CV Electricity; MH Test -Crossover Breaker Clearances
4, Elec.; Rec tacles and Lighting; Distanc s-GFI
.�
Drain; MH Test -Fall -Flex Connector
5. Elec.; Po/l Lighting; 15 volts-GFI
f—
ater; MH Test -Regulator -Connector
6. Elec.; closures; Conduit Entries -Terminal -Listed
y� „,_&_,Water and Sewer Connected -C/O to Grade -HD Approval
7. Elec./ Bonding; Metal w/5' -Circulating Equip nt-Heater
ZVrGas and Electricity Tagged
8. El,,,; Grounding; Equip. w/5' -Circulating Equip Pool Lghtg.
B es-Enclosures-Panelboards-Ins. to Main in C nduit
(j Exits; Insp.-Sketch
0 Cert. of Occupancy
9. ealth Department Approval
-6
10 Plumb; Cir. Test -Water Supply Test
Card B -I
Date Fe.F J Card -BI Date
Card -BI
Date Card -BI Date
Card B-1
Datey1.)0. a Card -BI Date
Card -BI
Date Card-BIDate
Electrical=
f&% Is service large enough to provide adequate 'amperage- to mobilehome � (must equal rating- f
mobilehome with a minimum of 10 amp) and other facilities.on lot, i.e.,. water pumps,
garage, cabana, etc..? Yes
JC_ Is there proper clearances around panels? --Yes_ No_
Is power supply cord or feeder assembly properly fused? Yes_ No_
cow
8-K Is continuity test satisfactory as per the following procedure? Yes o
1. De -energize electrical wiring system 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 lead of a test instrument to the mobilehome grounding conductor and
apply the other lead to each mobilehome supply conductor, including neutral.
5. All non-current, carrying metal parts of the mobilehome (aluminum siding, gas line,
water line), including fixtures and appliances, shall be tested for continuity from
such equipment and the grounding conductor.
6. Upon completion of the above procedure, the power supply cord or feeder assembly
conductors shall be connected to the site service equipment. A further continuity
test shall then be made between the -grounding electrode and the chassis of the
mobilehome. Upon satisfactory completion of the electrical tests, the lot or site
service equipment may be approved for energizing.
10. Is job card signed by Health Department for water and sanitation?
11. If everything okay, sign o
MOBILEHOME DATA
Manufacturer and/or Namestyle
Length W idth__,g�Z'
Vehicle Serial No.
State Identification No.
WW&FAWIffum
/,gap
Additional Information or Comments: f
k Z /ti`s T,v* ns: S' �9.,, `.� l�a ",v�.:� /o �.
/ '� Cd,aGlc. �4$ , Lu,ls % �E. %� l/J� �S % CJS/ /';0
Xu J,5 r £,r75Z.1cl.
At
oto ti
MOBILEHOME INSTALLATION INSPECTION CHECK LIST
lL Is the mobilehome located wit required separation from lot lines -and buildings and generally
conform to plot plan? -Yes No
Does the mobilehome have required clearances above ground? (Sec.5085) Yes c,' No
/1-- Are footings and supports properly sized, spaced, and braced as per approved plans? (Note
possible variation at spring shackles.) (Sec. 82 & 5083) Yes_
Is the mobilehome level? (Sec. 5088) Yes_ No_
0/1/–
If mor than a single unit, are crossover connections properly installed? (Sec. 5088)
Yes .. �No_
O/
DC Water
O/
A. Is flex'ble connector of adequate size and properly.installed (1/2" ID min.)? (Sec. 5566)
Yeso_
B. Test - Does water piping withstand working pressure or 50 lbs. air test? Yes No
Bad�,�ow - If coach is not State of California approved, does station have backflow device
and essure-relief valve? Yes No
016 Wastes and Drains
A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes o
B. Does it have minimum" per foot slope and is it properly supported? Yes No_
C. Are any leaks detected in drainage system after running 3-ga s of water through each
fixture including washing machine standpipe? Yes_ No
If ,'/yc�h is not State of California approved, does station have required trap and vent?
Yes 1ANo—
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 mob ile1xome gas line inlet without reductions other than the mobilehome
connector. Yes_!/No_
B. Test OK as per following procedure? Yes ' No
1. Open all appliance connector valves.
2. Shut off appliance burner and pilot valves. • . ,
3. Air test` with manometer to 10"-14" water column, or test with slope gauge (minimum
6oz.-maximum 8 oz.) calibrated in tenth pound increments. Test for 10 min. without
drop.
4. Connect gas meter to mobilehome with connector, turn on gas,,test connections with
soapy water.
Are all appliance vents properly installed? Yes �No
P74
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE
OROVILLE, CALIF. - 534-4541
CERTIFICATE OF OCCUPANCY
This mobilehome has been installed in accordance with therequaremeul.s
of the California Administrative Code, Title 25, Chapter 5, under permit
number 340 for the following location:
1' it 1 yn /.a�tri C- f &rr t .p 1 fit_
-r
Owner X�
Owner's Address
Mobilehome Mfg.. vG', Model U' ' Year r
Insignia No. ?C -'-'; -V - —7 Serial No. ~�
It is hereby certified for occupancy at the above described location and
may be occupied.
Director of Public Works
t i � !
Date ! ' )-C;) By k- �
THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED
White - Owner, Yellow - Installer, Pink - D.P.W.
1COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
695 Oleander Avenue, Chico — Phone 343-4211, Ext: 70
7 County Center Drive, Oroville — Phone 534-4541
Skyway and Elliott Road, Paradise— Phone 877-3435
C®[MIREC Tj6'%N
BUILDING OR PROPERTY ADDRESS
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.
O0P2 c & '40'�,'Od z o►-
Inspector Date ����y
JJ 'COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS IT NO
7 County Center (}rive - QrSville, CaafOrnia 95965 -Telephone 916/534-454
• APPLICATION AND PERMIT VVV
AS SSOR PARCEL NUMBER
$' —�—" —
ZO G
BUILDING PERMIT ., OZ)
o ER %
Oh.u> G- 2l.Zr
ELEPHONE
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
1-2
_YN9 TRACTOR' N E
TZLEPHONE
F92n95--iZ
'
O TRACTOR' MA ING ADDRESS
-
CONS RUCTION L909DER
UNKNOWN
Fireplace
Total Valuation $
LENDER'S MAIL ADDRESS
Permit Fee
$
ARCHITECT OR NGINEER
LICENSE NO.
Plan Checking Fee
$ U ��
Penalty
$
ARCHITECT O ENGINEER'S MAILING ADDRESS
Permit fee
$ v2 Q
UILD NG S
ZQ
PLUMBING PERMIT
Filing Fee
Each Trap
2.00
Repair drainage or vent piping
2.00
Water piping
LOT NO.
�3
SUBDIVISION NAME
PARCEL MAP
Each qas water heater or vent
2.0
Gas piping system 1 - 5 outlets
USE OF STRUCTURE
SF ❑ Duplex❑ Mobilehome Other
SPECIFY
Building sewer
Lawn sprinkler system
t2.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation Other ❑
Describe work: —
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 3.00
Main service &OOV OR LESS
100 AMP OR LESS
5.00
Q fr(
Main service EA. ADD'L 100 AMP
2.50
NEW LING O
OR ADDNST ( ACCLBLDGS.CCUP.&)
20 sq ft
CONTRACTORS LICENSE LAW
I declar der penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Profess' o e a my license is in ful rce a effect.
License N 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
NEW CONSTR ULTIOU TLET 2.50 ea
NON.RESID BRANCH CIRC ITS
NEWCONSTR (POWER APPARATUS &)
NON . RES I D. SINGLE OUTLET CIR.
so zsa
Ex. Occup(OUTLETS OR FIXTURES BAL@1
FIXED APPLNS. OR 1
Ex. OcCup.(OUTLETS (RESID.) EA.1 2. 0
Temporary service 1 .00
Mobile Home Facilities 5.00
Misc. Wiring 6.25
Permit Fee $
Contractor
WORKMEN'S COMPENSATION INSURANCE
1 declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
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.
MECHANICAL PERMIT
FiIingFee 3.0
Heating
Cooling
Hood
2.0
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 Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
also agree to save, indemnify and keep harmless the County of Butte against
al liabilities, .1 ts, costs, and expenses which may in any way accrue
agai t aid Count in onsequence f the granting of this peerrmit.
X l� Date O • ��-�
n -sions
Sig Lure f Applicant — Own Contractor ❑ Agent Y_ _
S permit is required for excavations over 5'0" deep and demolition or construct-
ion o structures over 3 stories in height.
Mobile Home Installation Fee $
Land Development Fee $
TOTAL PERMIT FEE $
occuP. GROUP
TYPE OF CONST.
PARCEL
P11
ND 1SSU
This permit is hereby issued under
of the Butte County Code and/or
work indicated above for which
DIRECTO PUBLIC
By
PT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date. f
2` /�j
Receipt No. ��� 7/%
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT
1-1
Z
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - OroJille, Caiifornia 95965 - Telephone 916/534-4541
APPLICATION AND PERMIT
AS ESSOR PARCEL NUMBER
��
Z ING
BUILD( ER IT
o ER
t7-Yt�C�O "Z�
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
C RACTO 'S A
TELEPHONE
TRAC33 TOR' MAI LI 'nAD'D%IR ESS
CONSTRUCTION M) ) / UNKNOWN
Fireplace
Total Valuation $
LENDER'S MAI INGA
RESS
Permit Fee 7ii
$ b
ARCHITECT OR EN ]NEER
LICENSE NO.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR E GINEER'S MAILING ADDRESS
Permit fee
$
BUILDING ADDRESS
Gc! o
PLUMBING PERMIT
Filing Fee /0.00
Each Trap
2.00
Repair drainage or vent piping
2.00
Water piping
/p. --
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Each qas water heater or vent
-"0- `Q. -
Gas piping system 1 - 5 outlets
USE OF S TURE
SF ❑ Duplex[] Mobilehome Other
SPECIFY
Building sewer
Lawn sprinkler system
.00
P
TYPE OF WORK/�
-�/
New ❑ Addition ❑ Remodel ❑ Utilities[Installation❑ Other ❑
Describe work: —
Describe
Permit Fee
$
Contractor e—'—
ELECTRICAL PERMIT
Filing Fee 1 /®.00
V OR L
Main service 1000 AMP ORSLESS
5.00
Main service EA. ADD'L 100 AMP
2.50 6-0
NEW CONST. DWELLING OCCUR.&
OR ADDNS. ( ACC. BLDGS.
20 sq ft
CONTRACTORS LICENSE LAW
I declare er penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professi C de an my license is in f force n effect.
License N � 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
NEW CONSTR U TI -OUTLET 2,50 ea
NON.RESI D, BRANCH CIRC ITS
NEW CONSTR/POWER APPARATUS &
NON -RES ID, (SINGLE OUTLET CIR,
Ex. Occup(OUTLETS OR FIXTURES 50@2i¢
BAL@10Q
FIXED APPLN OR
Ex. Occup -(OUTLETS (RESID.) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 6.25
Permit Fee $
Contractor po
MECHANICAL PERMIT
Filing Fee 3.00
WORKMEN'S COMPENSATION INSURANCE
1 declare under penalty of perjury (check one):
El e 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
2.00
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
nts, costs, and expenses which may in any way accrue
liabilities, IUd5conseque
agar t said Co tce of the granting of this permit.
Date iJ
Sign tore of Applicant — Owner ❑ Contractor ❑ Agent Q�
In 0 A permit is required for excavations over 5'0" deep and demolition or construct-
ion o structures over 3 stories in height.
Mobile Home Installation Fee $
Land Development Fee $
TOTAL PERMIT FEE $
OCCUP. GROUP
I TYPE OF CONST.
PARCEL
PD
ND
ssDE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOR OF P
By-
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
IC WORKS
D
Receipt No. �����
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR-, GOLDENROD -APPLICANT
uIN
NOM FAX N0. : 530-8733960
•
AL T' Cu"m
QZ-
FAX:
J'AX N�
Jun. 03 2003 02:09PM P2
665 360- Q"'
currrtn�ava Y4X �r-�
lkROM FAX NO. : 530-9733960
„Arra STATE OF CALIFORNIA—BU65S. TRANSPORTATION AND HOUSING AGENCY
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
DIVISION OF CODES AND STANDARDS
ACTIVITY REPORT
!Z�Reportby' L f 1,11/ ! (i aria AREA OFFICES
8911 Folsom Blvd.
Address ( 'S r� (�J tJ i' /�4n 1 :%�. C.� , �'! % P.O. Box 1407
Sacramento, CA
i':. '' • 95812.1407
i4ctivily Site (If other than above) � l� 2 � i v •;. An r.•J o� �. � � , .
Tel. (916) 255-250.1
OS -9th— A—
Owner (bother rh'in Dewe) ' ' 3737 Main Street
,. Stine 400
AddreSS;. Riverni". CA 92501
., Tel. 1909) 782.4420
:..ryKFUSO jGnecked I I as apprepria e
C� INSPECTIONRECORD.ONLY
INFORMATION ONLY
! • K. • NOQTICE O VIOLATION AND RELATED INFORMATION: This report provides notice
a4 vlctations of the CaGfomla H^ llh and Safety Code, OiAslon 13 or the California Code of Regulations,
"
4kS,Uiliillon-Cl*i . G , Sections. Indicated. Copies of the regulations may be obtained from
;.Barclays,YewWililIshii-P..O.:Box3066,South, San Francisco,CA aQ83.3066.
:"'•:via
lations'indi,BieQ tshall•be'.correcte�and'a written request for further inspection filed with the Area Once
'.:.illdicated.abgve:on ot'befome`,' �•' % - J i : _. The request foi inspection shall be
':.- accoriip=anted;tiy'arrili>rtnum'fee'ot.$ ., � .
#'permit shall be.'obtained.from•the Area Office identified above.for work to correct item(s)11
Il,yuu Eelieye tFii 1 n porlllas;tieen,.issued In'enor at is tactually inoonect_ please contact the Area
•%' StipelvlEior of the.'Aiee'Offiee fidicet9d abov '
Jun. 03 2003 02:10PM P3
DEPARTMENT USE ONLY
FILE IDENTIFICATION
CPT/ASSIGNMENT/ .
FAC. 10 s
LABOR DATA:
ORID_: )J DATE , C. •J�
PCA/ACT CODE'('/,/ � - REA
CO % (,/ I OC, TR MILES^_,.._
TIME: INSP/ACT „TR
INSPECTION DATA -
0 TIME REPORT ONLY
O INITIAL INSPECTION REINSPECTION
# HOME/UNIT i R FLOORS !gh
VIOLATION DATA:
TOTAL_ MP TENANT
S_J°_..._E_M_,_P G/O_...NP_
MH ALTERATION TYPE:
AC.O. . ACCO ROOF O FPD Do '
THIRD -PARTY MONITORING:
OAA ® HO D IP D DLO IS 0•
DAA #PLANS #COMPLY
MP INSPECTION DATA:
SLG/FtX—.— MH LOT_ RV LOT_..:.. AS
EH INSPECTION DATA:
q ACTIVE 0INACTIVE
MAX CAP P CAP.,,,,•—_ OCC'
SFD_-,.DORM MM/RV- O
s.
•,�= ;: _ _ FEE ACCOUNTING'
COL;.
2� e,_9
�:
I'_r::', , •; ....: -•,�"-,.""' �'' 'D�!e�ell Sit® ' RT DDcsI No. V- DUE ATTAdKrio
•E `f no's �
DeliarGnent of Ha/sinp 6 COmmunily Development
STA -E OF CAurC.KruAtel;
,
Division ^I Codes 8r•d StOndwdsF:tdtiL
INSPECTION LERTiFICATIQN.
6Y:
.
(Ols!rErA itepm;.cntBlivg) :to No.)
FEES: DATE
LIJ OR DATA: 7RZ 9Non1 I3 $ou1n CouniY.r�o: G�
1
/ L. • t._/�.1P,i�/t%2
I•Cn/ACT (',ODEJ6�r_/_&�.r : TR M18LZi3
ITF..AS IcSUED: HCO 50 ❑ Cas0 EiKI•ic C3 MA A.
IME: INSP/AC r Tr,AVEL T:M?
--�
p
bN-, C^� ''
_ �. rte., '�• _-----
INS'3ESTION DATA: yU yrlvat! pmparry Ll7M4 FAR:t"
DEPARTMENTAL USE.ONLY,:
f J/r�
D HONE/UNIT .4— ;LOOKS 7
PERMITNO: FILECLOSED
..
VIOLATION DATA: TOTAL CORRECTIONS:
6�P,4. OSP 01 66302
S —_ F-- E _,_ M , P _— C/O NP —
FEI COLLECTION AND OTHER INFORMATION:
.
FEES: DATE
•'
r
ITF..AS IcSUED: HCO 50 ❑ Cas0 EiKI•ic C3 MA A.
RECEIVED BY `` �)
--�
p
bN-, C^� ''
411TACHMENTS: ❑ TieduwnCert. ❑ (Ahtr __
DEPARTMENTAL USE.ONLY,:
Action:—
Close Fife
PERMITNO: FILECLOSED
❑ `Enforcement Aclion Needed
Other
Other
SEND COPIES TO:
❑ Recipient
❑Owner SAA 1._1 OL U Other
SUPERVISOR REVIEW
DATECQPIES SENT BY DATE '
' MCD -81 (Rev.09l)8).,
., .... PAGE —
1 'oi
6�P,4. OSP 01 66302
LJ
STAtt-OF.CAUFORNIA —BUSINESS. TRANSPORTATION AND HOUSING AGENCY
DEPARTMENT USE ONLY
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
FILE IDENTIFICATION
DIVISION OF CODES'AND STANDARDS
CPT/ASSIGNMENT/
ACTIVITY REPORT
FAC. ID 0
by Pie
LABOR DATA:
e6a (I A OFFICES
ARE
on to_ —DATE
)Sm.tlh -Atftm
PCA/ACT CODE
8911 Folsom Blvd.
Addie4 C/L 8" 1407
CO__Z) —,-/
M_ ILES
Sacrimento CA
TIME!'INSPIACT_yn
..A (ter 95812-140i
clivity'Site' YjIA,' 3-1
INSPECTION DATA: 7
Tel. 4916) 255-26011
A AA A [A. A -
M TIME REPORT ONLY
0S.IU11111A.
13 INITIAL INSPECTION 7REINSPECTION
3737 MStreet
I HOME/UNIT Ir FLOORS le—
suite 400
Aivmit.id., CA 92501
VIOLATION DATA:
TSI. 49081 702-4420
TOTAL f UP TENANT�
ruiiql--W:!L Vt- "tecad(V
S_L_F___E_.._M_P_
Tas a ppropflatel
-0:• 1INSPECTIONORD
0jo_Np_'
RECORD ONLY
MH ALTERATION TYPE:
INf N
MATIO. ONLY
AC
NOTICE OF VIOLATION AND RELATED INFORMATION:
9 ACC o ROOF a FP
THIRD
This report provides notice
thi.califorina"he Ith and Safety Code, Division 13 or the California Code of Reaulations.
-PARTY MONITORING;
:-filte.25 QWiiiiorl SwIlons indicated. Copies of the regulations may be obtained from
OAA @ MCI 0 IP 0 DLO IS 0
,...,,Barclays Lmw:Publishetsi P,.o,..Box 3006, South San Francisco, CA 94083-3066.
OAA *PLANS— #COMPLY
i Vlotations.iridicatsd shall be Eted and a written• request for further inspection filed with the Area Office
MP INSPECTION DATA:
r*d it
ickiad"abo*on',c "b -J 7
- 27 The request for inspection shag be
-by:
ULGIFIX MH LOT-- Rv LOT_ As_
i icc : iiripiiiiw, a irriiiunfee of$
E" INSPECTION DATA!'
.;..A .'00 . ftt4hali be`okkaihid: fr�m-lhi Area -Office identified above for work to Correct dem(s) X
n ACTIVE n INACTIVE,
MAX CAP_ P CAP OCC_
-.1 :0u.belleve,thii repo a� ..p'.t9tuad In error or is factually incorrect. please contact the Area
flj,..t
SFC—.-..—.DoRm_ NiHfRv�.
Su ii4 4.:.
cut
FEE ACCOP
1.1 IULPTIFICA I
COL*_4� e?
onfall site RT DWW N..
r 7-71 out: •A'm
STAT or CALWORNIA
DOP84ment of Housing & Community Davelopment
KU JLASEL,w::�
H DiviSi0m0f C00'eS iridl Stimda;0
FINAL INSPECTICN CERTIFICATION.
P.
OV: SNS , L�_
DAW:
R-j,mscnt&:iva) ;ID No.)
�INSPEGTKHW .-RESULTS. 10 KINK
"ZFA:
.
T:..-,. LAll IOR DATA: Nonh Sw. Count y 1,16: 4.
I T.CT 1,�CDE
INSPI.A.C7
-IME: Trzxwrt TAC
51 A
�-A
INS 3ESTION DATA: rivato,praqg.ty-4e
PAR.', i.A
2 HOmE,uNrr FLOORS
• VioiwriciN DATA: TOTAL COARECTiopm
J!
E M _ P
CK# A" 7
—La - .
GEES S ; (ZI
'i
0
_r4_rS.
CLOSED
TA
7
PERMIT NO:
Close
OL
AC11 Other 5'y---__P_AGE 1 of uSE-ONly' ropleS SENT
OV. AltrMENIAL. - .. eed 'A:k
P Cl Frijo(cemeAA. OiCT% S 1pient owner
SEND opir's TO, 13
SUPERVISOR REVIEW
----
,CD-6% krie'.081W " ,
Td wdeo:zo zow zo unj- 09'(4 L8 -02S : 'ON XUJ wodi
PERMIT NO. 5160-80B
PERMIT EXPIRES
t OWNER Antonio Zaragoza
CONTR. Sierra Mobile Serv., Paradise
ASSESSOR PARCEL 65-35-44
LOCATION 1235 Holmwood Dr., lot 103,SDC62,
Magalia
Temp. Power Pole
Called PG&E
Temp. Elec. Service
Called PG&E
Temp. Gas Service
Cal led PG&E
JOB FINALED (Date)
r r
Signature
= OK
= Not OK
= Not Applicable
= Not Ready RESIDENTIAL (Single and Duplex)
r,.
Date
UNDERFLOOR (PFan;) OK except #'s
Date
FRAMING (Continued)
1. Zoning requirements -Setbacks -Easements
48.
Property Line Firewall & Openings
2.
Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth
49.
Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
3.
Ftg., Garage; Soils -Steel- / /" Ftg. Depth
50.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
4.
Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth
51.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
5.
Stemwalls, Main; Steel-Blockouts-Wrapped-Slab
52.
Siding -Nailing -Veneer
6. Stemwalls, Garage; Steel -B lockouts -Wrapped -S lab
53.
Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access
7.
Piers -Fireplace Ftg.-Steel
54.
Glazing Area -Glass Protection -Skylights -Plastic
8. D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test
55.
Shear Walls; Nailing -Bolts
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
Card -BI
Date Card -BI Date
Card -BI
Date
Date Card -BI Date
FINAL (Plans) OK except N's
56. Ext. Steps -Door & Sidelight Protection -Landings
Card -BI
Date
Date Card -BI Date
PLUMBING (Permit) OK except q's
57.
Smoke Detector
14.
Water Ht.; Vent -Access -Combustion Air
58.
Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
15. Water Pipe; Test & Anchors -Nail Protection
16.
D.W.V.; Test-Fttngs & Anchors -Nail Protection
59.
Bedroom Exiting
17.
Shower Pan; Test, First Floor -Tub Access
60.
G.F.I. & Bath Fixtures & Tub Access
18.
Test Tub & Shower, 2nd Floor -Tub Access
61.
Elec. Trim & Subpanel; Breaker Sizes -Labels
19.
Gas Pipe; Size & Anchors
62.
Stairs & Rails
63.
Fireplace or Stove; Clearances -Hearth
64.
Elec. Outlets at Wood Panel; Int. & Ext.
Card -BI
Date Card -BI Date
65.
Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
Card -BI
Date Card -BI Date
66.
Elec. Outlets & Receptacles at Kit. Counter
Date
ELECTRICAL Permit OK except k's
67.
Garage Fire Door; Swing -Landing -Closer
68.
A.C. Duct in Garage -Damper
20.
Fixture & Transformer Clearance -Ins. Protection
69.
Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor-Mech. Protection
21.
Elec. Receptacles Spacing -Lights & Switches at Doors
70.
Plb., Elec. & Mech. Equip. Listed for Location
22.
Size Boxes & No. of Conductors -Stapled
71.
Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
23. Romex Installed Close to Edge of Studs & C.J.
24.
Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water
72.
Insulation -Foam -Looked in Attic ❑Yes
25.
2 Appliance Circuits in Kitchen & Conductor Size
73.
Guard Rails & Deck Construction -Post Caps
26.
Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or At
74.
Fdn. Vents &Crawl Hole Door -Drainage &Wood -Earth Clearance
Looked under Floor Cl Yes
27.
Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al,
Insulated Neutral ❑Yes ❑No
75.
Following instld.: Drive ❑ Yes ❑ No; Walks ❑ 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-Cirnces-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
Date
MECHANICAL (Perrr,it) OK except N's
83.
Corrections from Previous Inspections
84.
Gas Test -Meters Tagged; Gas -Electric
31.
A.C. Ducts; Insulation & Support
85.
Water & Sewer Connected -C/0 to Grade -HD Approval
_
32.
33.
Vent Fan; Exhaust above Insulation
Condensate Drain & Overflow; Size & Grade
86.
Energy Compliance Certificate -Other Certificates
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
Date
FRAMING(Plans) OK except q's
Comments
at Final:
36. Sills; Proper Material & Anchors
37.
Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound
_
38.
Bearing Walls over Girders & Floor Nailing
39.
Draft Stop in Walls (rat proof)
40.
Fire Stops; Furred Ceilings -Stairs -Chases -Tub
Header & Beam -Size & Bearing
_
_41.
42.
43.
44.
_
Hangers -Post Caps -Anchors -Connectors
Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng.
Fireplace Ties or Type A Flue -Fireplace Throat
45.
Attic Access: Size & Romex Protection -Draft Stop -Ins. Baffles
46.
Windows or Exiting Doors -Sill Hgt. & Dimensions
47.
_Bdrm.
Garage Fire Protection Framing
(NOTE: An entry must be made each time you visit job site)
= OK
= Not OK
Not Applicable MOBILEHOMES t MISCELLANEOUS
Not Ready
Date
MOBILEHOME UTILITIES, (Plans) OK except N's
Date
DECKS, COVERS, CARPORTS, ET(, Plan5hl< except #*s
1. Zoning Requirements—Setbacks—Easements
1. Zonin /Abquirements—Se s—Easements
2. Soils; Special MH Support—Sketch
2. F&Limirss; Size—Depth—Spa ing—Connectors
3. Sewer; Location—Test—Fall-C/0—Concrete
3. D irdarT-5-nd/or J ioe —Decking—BraLLag= airs—RNii
4. Water; Location—Test—Easement Needed (Sketch)
4, Wood Awn.; Posts—Beams—Rftrs.—Connec.—Shthg.—Rfg.—Bracing
5. Electricity; Location—Clearances—Grnd.—/ / Amp—Concrete
5. Alum. Awn.; Columns—Connections—Splice—Decal—Enclosures
6. Gas; Location—Test—Wrap:/ /"L"ft./ P'Nat.or/ /"L"ft./ /"LPG
7. Utility Clearance
6. Carports; Windows—Doors
7. Elec.
Card -BI
Date Card -BI Date
Card-BIlL
Date ) % Card -BI Date
Card -BI
Date Card -BI Date
Card -BI!:)
L_ Date Date
Date
MOBILEHOME INSTALLATION (Plans) OK except q's
1. Zoning Requirements—Setbacks—Easements
Date
POOLS (Plans) OK except ft'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
B. 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 -I
Date Card -BI Date
Card -BI
Date Card -BI Date
Card B -I
Date Card -BI Date
Card -BI
Date Card -BI Date
c
COUNTY OF,BUTTE - DEPARTMENT OF PUBLIC WORKS/PERMIT N
7 County Center Ddive - O.rpville, California 95965 - Telephone 916/534-4541 N5 6), 0 —(1 L/
APPLICATION.AND PERMIT Z' AiAl
ASSESS'OAR `P-�2CEL NUMBEq
W L 7
ZONING
ILDING PE
OWNER
TELEPHONE
SO. FT. I OCC. BUILDING VALUATION
%Z..04
OWNER'S MAILING ADD ESS -
/a3 15-- o �iri
CONTFJiACTOR'S NAME
ei i^cL d6/1e, ell e- e,
TELEPHONE
%-Gs7o
CONTRACTOR'S MAILING ADDRESS '
CONSTRUCTION LENDER /—' UNKNOWN
•
LENDER'S MAILING ADDRESS (�1.'
' •' `
Fireplace
Total Valuation $
Permit Fee
$ �
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Fee
$ ! u
yC�h�ecking
Y
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit 4(e IV$
BUILDING ADDRESS
PLUMBING PERMIT
Filing Fee 3.00
la_ -5's O�.r, Lido ,DSP.
Each Trap
2.00
Repair drainage or vent piping
2.00
�Gt leca�
Water piping
LOT NO.SUBDIVISION
NAME
PARCEL MAP
Each qas water heater or vent
2.00
Gas piping system 1 - 5 outlets
USE OF STRUCTURE
SF ❑ Duplex ❑ Mobi lehome ❑ Other
SPECIFY
Building sewer
Lawn sprinkler system
2.00
TYPE OF WORK
New Addition ❑ Remodel ❑ Uti lities ❑ Installation ❑ Othere
i
Describe work: is .� —
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 3.00
Main service 10001 OR 0 AMP ORLESS5.00
Main service EA. ADD'L IOO AMP
2.50
NEW CONST. DWELING
OR ADDNS. ( ACCLBLDGS.CCUP,&)
20sgft
CONTRACTORS LICENSE LAW
I de la under penalty of perjury (check one):
I am licensed under provisions of Chapt. 9, Div. 3 of the Businesseo@z5c
and Professions Code and my license is in full force and effect.
a� o?lo
License No.��Classification C° –4/
❑ 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
NEw CONSTR MULTI -OUT LET
NON-RESID. BRANCH CIRC ITS 2,50 ea
NEW CONSTR.POWER APPARATUS &
NON-RESID. (SINGLE OUTLET CIR.
Ex. Occup(o FIXTURES BAL@IOT
IXED A POR
LNS R
EE4Occup.(OUT ETS (RESID,)EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 6.25
Permit Fee $
Contractor
MECHANICAL PERMIT
Filing Fee 3.00
WORKMEN'S COMPENSATION INSURANCE
1 declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
VI 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
2.00
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 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, judgments, costs, and expenses which may in any way accrue
agai sa' i onsequence of the granting of this permit.
AV,
f Date
ure icon – owner ❑ Contractor ❑ Agent ❑
Signa-I.
An OSH permit is required for excavations over 5'0" deep and demolition or construct-
ion of s uctures over 3 stories in height.
Mobile Home Installation Fee $
Land Development Fee $
TOTAL PERMIT FEE $
OCCUP. GROUP
`'
I TYPE OF CONST,
PARCEL PD
N
ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECT OF PUBLIC
By
PE IT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date /� —i4 ZO
9
Receipt No. t./ 3 (, 3 3,
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD- A PPLICANT
"