HomeMy WebLinkAbout066-120-002AP 66-12-22
J. Mettz 46V(2�e
/J�?,rgalia22 Eureka r.0
CONTR: Par-A-Dise Constr.,Paradise
Permit 5817-77B,P;E;M (new SF
66-12-2
WILLIAM E. WOOSELEY
13712 Eureka, Magalia
Contr : Fred Cox J
�yermit#1844-85B(add,,patio,cov.er./SF)
a
PERMIT NO. 5817-77B,P,E,M
PERMIT EXPIRES-', 11/cf 417 e
OWNER J. Mettz,
CONTR. Par-A-Dise Constr., Paradise
LOCATION (A.P. 66r12-2
22 Eureka Dr., Lot 2, PPCC#2, Magalia
K.
Temp. Power Pole
Called PG&E
Temp. Elec. Serv.
Called P &E
Temp. Gas Serv.
ed PG&E
JOB
• FINALED (Date)
(Si gnature)
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION RECORD
BUILDING BUILDING (Cont'd) PLUMBING
Setback -
1 % n
Firewall
Soil Piping '
,Forms
Heating
Parapets
1st Floor
Main Bldg.
Cooling
Restroom Finish
2nd Floor
Footings
Ducts 1
Windows
3rd Floor
Stemwall
IW
Siding
To out / l
Slab
Final
Roof Sheathing
Water Pi in
Piers
Elec. Pedestal
Roofing
Sewer
Garage
Gas Piping
Fdn. Vents
Fixtures
Footings/
Stemwall 1'2--'/,')
1210
J
Garage Vents
Insulation
Water Htr.
Heaters
Slab
Carport
Footings
Prov. for phslcally
handica edy
Conformance of ex.
structure z
Appliances
Gas Piping &Test
Temp. as
Slab
Final - `" 27 1
Sanitation
Patio
FIREPLA
Final --Z-7
Footings
Footing
ELECTRI
MasonryWalls
Throat
Rough
Reinf. Steel
Final -7
Fixtures
Bond Beam
FIRE SPRINKLERSK
Motors
Framing '7,--90-7E
Test
Water Htr.
Stucco
/I
Final
Suhnnnala
mesh
MECHANICAL
Grd. Fault Prot.
Scratch
Heating
Service
Brown
Cooling
Temp. Pole
Finish
Ducts 1
Underground
Interior Lath
Ventilation
Permanent
9
Door Closer
Final
Final
of
2 7
MOBILEHOME UTILITIES ------------------ Elec. Service
Elec. Pedestal
Water Piping
Sewer
Gas Piping
M00116EUOME INSTALLATION - - - - - - - - - - - - - - Support
Elec. Continuity
Water Piping
Drainage
Gas Piping
DATE REMARKS OR CORRECTIONS
U����
(NOTE: An entry must be made on this form each time you visit the job site.)
Owens-Corning
Fiberglas
Insulation
The manufacturer recommends installation as follows to achieve
the stated thermal resistances (R values)
Blanket
Insulation
(Complies with Fed
Spec. HH -1-521 E)
minimum
to obtain an installed
insulation thickness
R of: I should be:
R-30
9"
R-26
81/4 "
R-22
61/2 "
R-19
6"
R-13
3%"
.R-11
31/2"
Blowing
Wool
(Complies with Fed.
Spec. HH -1-1030a type 1)
The weight per
minimum sq. ft. of installed
to obtain thickness insulation should
R* of: I should be: be not less than:
minimum
1
bags per
maximum
1000 net
inetcoverage
sq. ft.
per'bag
should be:
I should be:
R-30
13 3/4 "
0.7681bs. per sq. ft.
30
33 sq. ft.
R-26
12"
0.670 lbs. per sq. ft.
27
37 sq. ft.
R-22
10"
0.558 lbs. per sq. ft.
22
45 sq. ft.
R-19
83/4"
0.489 lbs. per sq. ft.
20
51 sq. ft.
R-11 1
5"
0.279 lbs. per sq. ft.
11
90 sq. ft.
'Per ASTM
C-687 8 C-236
Statements of Compliance
Batts/Rolls have been installed in Blowing Wool has been installed in ceiling areas
accordance with the above to
provide an R of4�_in ceiling areas,
_4�_ in exterior walls, and Lj— in
floors or crawl space perimeter
in accordance with the above to provide an R of,
using bags of insulation to cover
net sq. ft. of area
date t 7ef
installed by:
(company name) signature
ilde
(company name) signature
1
OWENS/CORNING
FIBERGLAS: O
OWENS-CORNING FIBERGLAS CORP.
Insulation Operating Division
16 -BL -6558-B Litho in U.S.A., May 1976 Fiberglas Tower, Toledo, Ohio 43659
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC
7 County Center Drive - Uroville, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
WORKS /1_7 7
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X Svi 'rD ate %1- 7- 7 %
Signature of Permitee or�nt
Receipt No.
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECTOR OFIn'UBLIC WORKS
By / ate 717
Building permit expires Date // - 30- 7 F
BUILDING
r1
Owner %�"�-
J � .
SO. FT. OCC. BUILDING VALUATION
S
Mai l i ng Address
Telephone No.
Fireplace
/3
Contractor - 4 Lot C(4 1, oo s 7
Total Valuation 23
Mailing Address (�2 yg, u CiC To
Permit Fee ® ^-
Plan Checking Fee&/or Penalty
a a
T�gle hone N j
Z
Permit Fee
Building Address
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00 �-
,c1
d� 2 � L4�� �/�
Each Trap 1.50 I Z
® TZ Cl�f2
Repair drainage or vent piping 1.50
Water piping 1.50
C. t. Zoning Verificafion Only
Each gas water heater or vent 1.50
A. P. No. ��-
onin Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
Fkae W. io Fire Dept. FireZo Use Permit
EQA Parking Parcel Parcel Ma 60' R/W Improvements
Plans Declaration P P
Building sewer 5.00
Lawn sprinkler system 2.00
Bld�ns Recd
I Por pprovol
P Approval
Permit Fee $ Cp 4S,
$
NEW ADDITION ❑ UTILITIES ❑ OTHER ❑
ELECTRICAL No.1 @ FEE
PERMIT FILING FEE $3.00
Main service 100 AMP OROR LESS5.00
Main service EA. ADD•L 100 AMP 2.50
ER 600V
Main service 10 0 AMP OR LESS 25.00
Single Family [y Duplex ❑ Mobil Home ❑ Others ❑
Main service EA. ADD'L 100 AMP 1.00
NEW CONST. DWELLING &
OR ADDNS. ACC. BLD S. �) 22sgft i—
NEW CONSTR. MULTI - TL
NON.RESID. BRANCH CIRCUITS) 2.50ea
NEW CONST/POWER APPARATUS &)
NON•RESI D. (POW
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 : r
Qall `
Ex. Occup(OUTLETS OR FIXTURES) 50025
FIXED APPLNS. OR
Ex. Occup.(OUTLETS (RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No.�Classification ��
Misc. Wiring 6.25
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $ Ll 0.
$41d
WORKMEN'S COMPENSATION INSURANCE
I am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
❑I certify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
MECHANICAL No. @7. FEEPERMIT
FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 1 2.00 _2—
Permit Fee $ 3 —
$
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
CA . L -
TOTAL PERMIT FEE
$
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
X Svi 'rD ate %1- 7- 7 %
Signature of Permitee or�nt
Receipt No.
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECTOR OFIn'UBLIC WORKS
By / ate 717
Building permit expires Date // - 30- 7 F
RESIDENTIAL PLAN CHECKING; GU IDE '
.. (S.F., DUPLEX, & MISC. ONLY)
Bldg. Pe �'t #6-1F/7-77'
OWNER A. P. #(o /a. —
n
Zoning requirements
Valuation.
3. Signature by R.C.E.
(sideyards and parking).
or Architect (if required).
B. PLOT PLAN
/i! Complete parcel size and dimensions.
Setbacks, sideyards, easements, etc.
3. Other buildings or structures.
4. Grading, fills, drainage.
C. FLOOR PLAN
Complete to scale plan with dimensions.
�,. Required windows for light and ventilation (Sec. 1405).
33'. Required windows for second exit (Sec. 1404).
Allowable glazing for energy requirements (20% max. per State law).
ff' Human impact glass (Sec. 5406).
,--6. Required room sizes, ceiling heights (Sec. 1407).
G.F.C.I.'s in baths and exterior outlets (Sec. 210-8).
Light fixtures, switches, receptacles, and exterior receptacles for maintenance of
mechanical equipment.
,,91V Locations of water heater, heating & cooling equipment, other electrical or gas
equipment, and plumbing fixtures.
48': .Garage firewall, door size, and closer (Sec. 503(d)(4)).
cYl_ 1 - 3'0" exterior exit -door (Sec. 3303d).
107ZFireplace location.
Smoke detectors (Sec. 1413).
D. STRUCTURAL DETAILS
F6unrdation plan complete enough to construct building.
Fio q construction details complete enough to construct building.
Eievations and wall construction details complete enough to construct
Roof construction details complete enough to construct building.
.Fireplace construction details and calcs if over one-story in height.
. Sufficient data and details to satisfy energy insulation requirements
E. MISCELLANEOUS ITEMS TO LOOK OUT FOR
,,kf CCX plywood on exposed locations and overhangs.'
2. Stairway details (Sec. 3305).
3. Guardrail details (Sec. 1716).
4. Brick or stone veneer (Chapter 30).
5. Exterior plaster — weep screeds (Sec. 4706 & 4708).
,,,,6: Proper roof pitch for roof covering (Chapter 32).
Rafter ties or bearing ridge beam.
__-8— Garage door or porch header sizes.
Ade uate bracin
building.
(State law).
q g•
10. Living area over garage - complete 1 -hour separation required including supporting
walls and posts, etc, %
11. Two (2) exits on three-story dwellings (Sec. 3302).'
PERMIT NO. 1844-85B
-PERMIT EXPIRES- /&42
OWNER WILLIAME, OOSELEY
CONTR., Fred Cox, Paradise
ASSESSOR PARCEL 13712 Eureka, Magalia.
LOCATION 66-12-02.
Temp. Power Pole
Called PG&E
Temp. Elec. Service
Called PG&E
Temp. Gas Service
Called PG&E
JOB FINALED (Date)
Signature
J = OK
0 = Not OK
= Not Applicable MOBILEHOMES MIS4ELLANEOUS
= Not Ready
Date MOBILEHOME UTILITIES (Plans) OK except N's Date DECKS, COVERS, CARPORTS, ETC. (Plans) OK except N's
1. Zoning Requirements -Setbacks -Easements 1. Zoning Requirements -Setbacks -.Easements
2. Soils; Special MH Support -Sketch 2. Footings; Size -Depth -Spacing -Connectors
3. Sewer; Location -Test -Fall -C/0 -Concrete 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
4. Water; Location -Test -Easement Needed (Sketch) . Wood Awn.; Posts- Beams-Rftrs.-Con nec.-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./ /"Nat. or/ /"L"ft./ /"LPG 6. Carports; Windows -Doors
7. Utilitv Clearance 7. Elec.
Card -BI
Date Card -BI Date
Card -BI
QGr Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Date
MOBILEHOME INSTALLATION (Plans) OK except #'s
Date
POOLS (Plans) OK except N's
1. Zoning Requirements -Setbacks -Easements
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/O to Grade -HD Approval
7, Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater
8. Gas and Electricity Tagged
8, Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool Lghtg.
9. Exits; Insp.-Sketch
Boxes-Enclosures-Panelboards-Ins. to Main in Conduit
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
= OK
= Not OK
= Not Applicable
= Not Ready RESIDENTIAL -(Single and Duplex)
Date
UNDERFLOOR Plans OK except #'s
Date
FRAMING Continued
1. Zoning requirements -Setbacks -Easements
48.
Property Line Firewall & Openings
2.
3.
Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth
Ftg., Garage; Soils -Steel- / /" Ftg. Depth
49.
50.
Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
4. Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth
5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab
6. Stemwalls, Garage; Steel -B lockouts -Wrapped -S lab
51.
52.
53.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
Siding -Nailing -Veneer
Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access
7. Piers -Fireplace Ftg.-Steel
8. D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test
54.
55.
Glazing Area -Glass Protection -Skylights -Plastic
Shear Walls; Nailing -Bolts
9. Gas Pipe; Size -Anchors
10.
Water Pipe; Test-Anchors-Regulator-Seryice 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
Card -BI Date Card -BI Date
Date
PLUMBING (Permit) OK except k's
14. Water Ht.; Vent -Access -Combustion Air
56.
Ext. Steps -Door & Sidelight Protection -Landings
57.
58.
Smoke Detector
Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
15.
16.
Water Pipe; Test & Anchors -Nail Protection
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
Card -BI
Date Card -BI Date
64.
65.
Elec. Outlets at Wood Panel; Int. & Ext.
Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
Card -BI
Date Card -BI Date
66.
67.
68.
Elec. Outlets & Receptacles at Kit. Counter
Garage Fire Door; Swing -Landing -Closer
A.C. Duct in Garage -Damper
Date ELECTRICAL Permit OK except q's
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
22.
Size Boxes ll No. of Conductors -Stapled
70.
Plb., Elec. & Mech. Equip. Listed for Location
23.
Romex Installed Close to Edge of Studs & C.J.
71.
Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
24.
Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water
72.
Insulation -Foam -Looked in Attic E] Yes
25.
2 Appliance Circuits in Kitchen & Conductor Size
Guard Rails & Deck Construction -Post Caps
26.
Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al
74.
Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance
Looked under Floor ❑ Yes
27.
Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al,
Insulated Neutral ❑Yes ❑No
75.
76.
Following instld.: Drive E3 Yes E]No; Walks ❑Yes EDNo;
Planters ❑Yes ❑No
Stucco; Brown -Finish
28. Service -Riser Conductors & Ground -Main Disconnect
29. Equip. Clearances; Panels-Motors-Mech. Equip.
30.
Clothes Closet Light -Shower Light
77.
A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet
78.
Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs.
79.
80.
Water Well; Disconnect, Electrical, Plumbing
Exterior Elec. Trim; G.F.I. Receptacle -Underground
Card B -I
Date Card -BI Date
81.
82.
Ventilation throughout House
Glass Protection
Card B -I Date Card -BI Date
Date
MECHANICAL (Permit) OK except q's
31. A.C. Ducts; Insulation & Support
83.
84.
Corrections from Previous Inspections
Gas Test -Meters Tagged; Gas -Electric
85.
Water & Sewer Connected -C/O to Grade -HD Approval
32.
Vent Fan; Exhaust above Insulation
86,
Energy Compliance Certificate -Other Certificates
33.
Condensate Drain & Overflow; Size & Grade
34.
Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet
35.
Attic Access & Platform if Furnace in Attic
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Comments at Final:
Date FRAMING Plans OK except q's
36.
Sills; Proper Material & Anchors
37.
Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound
38.
Bearing Walls over Girders & Floor Nailing
39.
40.
Draft Stop in Walls (rat proof)
Fire Stops; Furred Ceilings -Stairs -Chases -Tub
41.
Header & Beam -Size & Bearing
42.
Hangers -Post Caps -Anchors -Connectors
43.
44.
Cing. Joist-Rftr. Ties-Purlin- Roof _Brac_.-Truss--Shthng.-Rfn_g_._
Fireplace Ties or Type AFlue-Fireplace Throat
45.
Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
46.
47.
Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions
Garage Fire Protection Framing
(NOTE: An entry must be madeeach time youvisit jobsite)
COUNTY OF BUTTE -DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, C41ifornia-95965 - Telephone 916/534-4541
APPLICATION AND PERMIT
ASSESS R PARCEL NUMBER
Y
ZONIN
Ni
BUILDING PERMIT
OWNUj;JliaWTELEPHON
Cja-1 �D Er E'-
SQ. FT. OCC. BUILDING VALUATION
�II
OWNER'S AILING DRESS ^�
/ �i/l
C 0NT.¢Al T R S N 0
TE 4PHONE
CONTRACTOR'S MAI G DRESS
qJ `
Fireplace
COEA1151IR
UNKNOWN
Total Valuation $
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHIT. CT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$ .�
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDING ADDRESS
3? 1A V� A a
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Solar Water Heater
20.00
a
Water piping
5.00
LOT NO.SUBDIVISION
NAME PARCEL MAP
Each qas water heater or vent
5.00
Gas piping system 1 - 5 outlets
5.00
USE OF STRUCTURE /—
SF ❑ Duplex ❑ Mobi lehome ❑ Other 1 O �C7 (/� Y
SPECIFY
Building sewer
5.00
Mobile Home S I G W
10-00ea
TYPE OF WORK
New ❑ Addition Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe work:
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service BOOV OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. DWELLING OCCUP.&
OR ADDNS. ( ACG. SLOGS.
2/4sgft
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 m license is in full force and effect.
y
I
License No. 27 O / I Classification f s
❑• 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. ULTI.OUTLET 2,50 ea
N.N.RESID BRANCH CIRC ITS
NEW CONSTR. POWER APPARATUS &
NON-RESID. SINGLE OUTLET CIR.
Ex. Occu 20@50a
P�ouTLETs OR FIXTURES BALQ 30
FIXED APPLNS. OR
EX. Occup. OUTLETS (RESID.) EAJ 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Heating
Cooling
Hood
3.00
Ventilation
permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree, to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the 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
against said CouuA/ty in c51" .sequence of the granting of this permit.
X �te/JC �'/ Date
Signature of Applicant — Owner ❑ Contractor Z 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 $
AS
TOTAL PERMIT FEE $ J
OCCUP. GROUP
I TYPE OF CONST.
'�
PARCEL
PD
I HD
ISsu
1.
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTO F PUBLIC
By
PERM EXPIRES Date
the applicable
resolutions to do
to do
fees have been paid.
WORKS
Date 7-3
Receipt No.
WHITE-D.P.W., YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT
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COUNTY OF BUTTE - DE PARTMENT•;OF-PUBLIC WORKS - BUILDINGlDIVISION
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 96%534-4541
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PERMIT APPLICATION DATA SHEET
OWNER
Proposed Building Use,
Permit Fee Based Upon
Complete Contract Price
Other (Explain)
Permit No. /
A. P. No. /�q/,/
DPW Valuation
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Building Inspector 4.4&�! 1j,40 Date
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At time of ermit application, I was advised the followfing data must be submitted prior to permit processing
and:/or * SUance: DATE RECEIVED APPROVED
1. All items have been submitted. . . . . . . . . . . .
2... Plot plans in duplicate./triplicate: . . . . . . . . . .
3. Complete plans in duplicate. /triplicate. . . . . . . . .
4. Complete engineered plans and calcs. . . . . . . . . .
5. Plans with Energy Design Compliance Statement. . . . . .
6. State Energy Forms No.
7 Statement of Intent for Non -Heated and AC Buildings.
8. Fees of $ . . . . . . . .
9. Letter of signature authorization. . . . . . . . . . .
10. ,Sanitation approval from Health Dept. . .
Planning approval for (A) Use: - (B) Parking:
1�1 - Certificate of Workmen's Compensation Insurance. . . . . .
13. Contractor's License Information (no., name style, classif.)
14. Owner -Builder Verification (Given to owner0, Mail to owner ❑.)
15. Improvements may be required. . . . . . . . . . . .
16. Mobilehome Installation Data. . . . . . . . .
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17. Pre -Inspection for RequiredPre-Inspec. request to. Building Inspector
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(Dare)
18. Recorded copy of Agricultural Acknowledgment Statement.
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19. Other
When you issue the permit, process as follows: Mail to owner.
Mail to contractor.
Telephone and hold for pickup at office.
Deliver w. /inspector.
Copy of plans sent Health Dept., Fire Dept., Other Date
During the plan checking process, the following data must be submitted prior to permit issuance:
(For required items not checked above at time of application, circle item.)
1. Index permit for above Items No.
2. Additional items required:
(Contractor, Designer, Owner) was advised of above required data by Telephone
By
Plans checked by
Plans approved b,
Other:
Copy—DPW
Date
Date
-Mail Other
Date
TO.: Building Department.'
FROM: Environmental Health
SUBJECT: SANITATION CLEARANCE
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66 , I Z —(� L
OWNER
LOCATION
AP #
Plans approved for:
Sewage Disposal
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Water Supply
Hold final for:
Water Supply
Final Clearance O.K. for:
Clearance for bedroom mobile home. Other
Water Supply
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