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HomeMy WebLinkAbout066-230-00666-23-6 Teno Prieto 920.Andover, lot 156, CC#4, Magalia contr: Feather River Const.,'Magalia Permit #k 45-76P,E(utiMH) lo. . 2$ - � �� GAS SUPPO T S RUCTURE REQ..>2La ,`,�� COMPACTION'TEST'REQ. GtN WnQ�` 66-23-6 Walter E. Wille _r 920 Andover Dr:, lot 156, CC#4,Maga. • � contr • ,Par �i _,.�, d 1 C t • • � a se �o u ar oncep s `Permit #6730-76MHI(for permit:#3454-76) Issued AP 66=23= Permit 130-7.7P '. (gas; piping.rfor.,,., , 3454-76/MH) i a1ha� 66-23-6 r, Permit #508�77B(new deck/MH) X 0 • 1 0 r a v C.L7I Chia Mj -77'B4. PERMIT NO. 508 PERMIT EXPIRES MI&1 7i OWNER Walt Willert CONTR. owner LOCATION (A.P. 66-23-6 920 Andover Dr., lot 156, C04, Magai1a } t f Temp. Power Pole Called PG&E Temp. Elea Serv. Called PG&E Temp. Gas Serv. Called PG&E JOB FINALED_ / G (Date) (Signature) COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS c BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING Setback Firewall Soil Piping Forms Parapets 1st Floor Main Bldg. Restroom Finish 2nd Floor Footings Windows 3rd Floor Stemwall Siding To out Slab Roof Sheathing Water Piping Piers Roofing Sewer Garage Fdn. Vents Fixtures Footings Stemwall Garage Vents Insulation Water Htr. Heaters Slab Carport Footings Prov. for physically handicapped Conformance of ex. structure 1 Applian2es Gas Piping& Test Temp. Gas Slab Final Y v Sanitation Patio FIREFUCE Final Footings Footing ELECTRICAL Masonry Walls Throat Rough Reinf. Steel Final Fixtures Bond Beam FIRE SPRINKLERS Motors Framing Test Water Htr. Stucco Final Subpanels Mesh MECHANICAL Grd. Fault Prot. Scratch Heatina Service Brown Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation Permanent Door Closer Final Final MOBILEHOME UTILITIES ------------------ Elec. Service Elec. Pedestal Water Piping Sewer Gas Piping E ME INSTALLATI N - - - - - - - - - - - - - - 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.) COUNTY OF BUTTE — ' 6E0ARTMENT OF PUBLIC WORKS 7 County Center Drive — Uioville, California 95965 Tel eph&ne: 534-4541 APPLICATION AND PERMIT authorize repr entat(ves of the County f Butte to enter upon the above -m d property for inspecti purposes. ate J Signature of Perrmitee or Agent 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. -. DIREJ ZOR OF J3UALIC WORKS By Date/I I 2! Building permit expires Date ,�9�* BUILDING"t Owner SQ. FT. OCC. BUILDING VALUATION_ Mai I i ng Address _ Telephone No. Fireplace Contractor Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ s Address PLUMBING LUMBING No. @ FEEg PERMIT FILING FEE $3.00 r a Each Trap 1.50 G, V� Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 A. P. No. a3 ^ Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fe W. ion Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA I Parking Plans Parcel Declaration P rcel Ma p 60' R/W Improvements provements Lawn sprinkler system 2.00 Bldg. PI Recd arcel Approval Plans Approval Permit Fee $ $ NEW ADDITION ❑ UTILITIES ❑ OTHER ❑ ELECTRICAL No.1 @ FEE PERMIT FILING FEE J$3.00 600V OR L Main service 100 AMP ORSLESS 5.00 Main service EA. ADD'L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home,J Others ❑ Main service R 600V 1100EAMP OR LESS 25.00 Main service EA. ADO'L 106 AMP 1.00 NEW CONST. DWELLING OCCUP. & OR ADDNS. ACC. BLDGS. ) 2¢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: Ex. Occup(OUTLETS OR FIXTURES) BAL@1 00 Ex. Occu FIXED APPLNS. OR P'(DUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 ®-I-7am—exempt from the Contractors License Laws of the State of California. Permit Fee $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. 1:1 I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. ify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of _ California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby I TOTAL PERMIT FEE $ '— authorize repr entat(ves of the County f Butte to enter upon the above -m d property for inspecti purposes. ate J Signature of Perrmitee or Agent 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. -. DIREJ ZOR OF J3UALIC WORKS By Date/I I 2! Building permit expires Date ,�9�* t a 3454 -76P -,E---- PERMIT NO. PERMIT. EXPIRES OWN . ER Teno Prieto CONTR.Feather diver Const., Magalia LOCATION (A. P. 66-9. 3-6 920 Andover Dr;:, lot 156,C04, Magalia Temp. Power Pole Called PG&E Temp. Elec. Serv.. -Called PG&E qq/ Temp. Gas.-Serv. alled PG&E JO B AL�J/ 2 FIN ED (Date) rV T (siOa ure) w m 4$ u COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS ' BUILDING INSPECTIONRECORD ' BUILDING BUILDING (Cont'd) PLUMBING Setback rewall Soil Piping rms Parapets 1st Floor -•—'`"— in Bldg. Restro Finish 2nd Floor otin s Windows 3rd Floor ------- Ste wall Siding To out Slab Roof Sheath g Water Piping —7 Piers Roofing Sewer _ / -7(- Garage 7(,Garage Fdn. Vents Fixtures Footings Garage Vents Water Htr. Stemwall Insulation Heaters ��— Slab Prov. for physically Appliances handica ed Carport Conformance of ex. Gas Piping &Test Footings structure Temp. Gas Slab V Final Sanitation Patio FI EPL CE Final Footings Footing L CTRICAL kasonry Walls Throat Rough Relnf. Steel Final Fixtures Bond Beam IRE SPRINKLE Motors Framing Test Water Htr. Stucco_ Final Subpanels Mesh MECHANICAL Grd. Fault Prot. Scratc Heatin Service Brow Cooll g Temp. Pole F1 sh Duc Underground Int for Lath VeAllation Permanent 77 Dor Closer Final Final DATE REMARKS OR CORRECTIONS �L ��L"!/t�i (may• r . %rD 77 hro.6Qd,� e t, - 0J, 77SSctcd (NOTE: An entry must be made.on this form each time you visit the job site.) �` , r' 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 the requirements of the C4lifornia Administrative Code, Title 25, Chapter 5, under permit number '6716-- '74 for the following location: Owner' 41,4471r,- LI// L -7— Owner's Address �'_. Q 0A"dQ/. Mobilehome Mfg. Mex-,VV Rei ,e%.tr- Model Year r!� Insignia No. :-AL IM63 a you G y Serial No". �— 4C d It is hereby 'certified for occupancy at.the above described location and, may be occupied. t Directors f Public Works Date J / /� By I/THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED ii0t3T+ l liO:tG INS`1ALLATION 1NSPFCTION CHECK LIST 1. Is the mobilehome located w'ich required separation from lot lines and' buildings and general].; conform to plot plan? -Yes e No_ ?• Doc,;; the mobilehome have requirecl clearances above ground? (Sec.5085) Yes No 3. Are footings and supports properly sized; spaced, and braced as pe 'approved plans? (Note possible variation at spring shackles.) (Sec. 5082 & 5083) Yes / No 4. Is the mobilehome level.? (Sec.. 5088) Ycs_ZNo_ 5. If more than a single unit, are crossover connections properly installed? (Sec. 5088) Yes t,-<, o 5'. Water A. Is flexi_.le connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes c B. Test - Does water piping withstand working pressure or 50 lbs, airiest? Yes1-moo C. Backflow - If coach�i notate of California approved, does station have backflow device and pressure-relie valeo Yes No 7. Wastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes "No B.. Does it have minimum ," per foot slope and is, it properly supported? Yes L --Yb `C. Are any leaks detected in drainage system after running 3 -gallons of water through each fixture including washing machine standpipe? Yes_ No D. If col��ot State of California approved, does station have required trap and vent? Yes 8. Gas Piping and Gas Vents A. Connector - Is mobilehome connected to the gas supply with an approved 3/4" minimum mobilehome connector not more than 6 ft. long? Note: All piping is to be at least as large as the mobYile.ome gas line inlet without reductions other than the mobilehome connector. iYes 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. C. Are all appliance vents properly installed? Yes t/ No ' 9. Electrical J -r A Is service large. enoitglt to provide adequat_o amperage to mobile.liome (must equal rating, of mobilehome with a s;iniu,:um of 100 -,amp) and other faciliti.csa on lot, i.e., water pumps, ,,arag,e, cao.ina, etc.'? Yes No_ B. Is then--� proper clearances around panels?- Yes C. Is power supply cord or feeder assembly properly fused? Yes No` D. Is continuity test satisfactory as per the following procedure? YesX/IVo__ 1. De -energize electrical wiring syste:ii of the mobilehome at the pedestal. 2. Make sure that the power supply cord or feeder assembly conductors, including neutral conductor, havc> been disconnected. 3. Switch all •breakers and switches in the mobilehome to the "on" position. , 4. Connect one 1':' -.:id of a test instrument to the mobilehome grounding conductor and a "y tine o'll-e lead to each mobile<<i>�ne SupplyconUuctoi, including neoLral. �p 5. All nor. -current, carrying metal parts of the mobilehome (aluminum siding, gas line, water line), including fixtures and appliances, shall be tested for continuity from such egt:ipment and the grounding conductor. 6. Upon completion of the above procedure, the power supply cord or feeder assembly conductors shah be connected to the site service equipment. A further continuity te::;i_ shall then be made between the grounding electrode and the chassis of the crobilehome. Upon satisfactory completion of the electrical tests, the lot or site service equipment may be approved for energizing. ;.Ci, I:, job card signed by health Department for water and sanitation? ll.. If evo ything okay, sign off card and tag, services. MOBTLisiIOML_DATA Manufacturer and/or Namestyle Length_-C/iJ _ Width z�— Vehicle Serial No. State Identif icat i..on No. A- Alf 006.3f �yem�y 4 &; L t ional Infor zna t i on or Corcunents : y . COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — Oroville, California 95965 A/� Telephone: 534-4541 / i/(!,f[ APPLICATION AND PERMIT 11 aLi UIi— 1VVIU0crli0u VCO UI mt: uumity UI mutte to enter upon the above- Toned propert for ' pection purposes. Date //-// —77 Signature f Permitee or Agent Receipt No. �, & D, a� White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By � Date %-- / (— % '7 SBudilitm permit expires tate BUILDING Owner L -Y SQ. FT. OCC. BUILDING VALUATION Mailing Address e7-/? 9 I✓ y I - C -c c— _ Telephone No. b3 - a 6 � 9 Fireplace Contractor Total Valuation Mailing Address v— Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee Building Address p �f /{/�% gr PLUMBING No. @ FEE PERMIT FILING FEE $3.00 3,0p /U%s�G� Gi,ly Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 A. P. No. �- .- (� Zoning & Planning Gas piping system 1 - 5 outlets 1q=1110 AD -0 Each additional outlet .30 F S•aw4 t= FireDept. FireZone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration Parcel Ma P 60' R/W Im provements Lawn sprinkler system 2.00 a ane Parcel Approval Plans Approval Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 QO/ q/ 6 a ✓ g ify t 7- att Main service 100 AMP ORSLESS 5.00 Main service EA. ADO'L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home ® Others ❑ Main service OVER 600v 25.00 10o AMP OR Main service EA. ADD'L 100 AMP 1.00 0 AM (DWELLINGNEW CONST - OR ADDNS. ACCCCUBLDGS.P. &\ 2¢sft NEW CONSTR MULTI -OUTLET NON -RE" .. BRANCH CIRCUITS) 2.50ea NEW CONSTP- (PO ER APPARATUS & NON.RESI D. (SINGWLE 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)@� BAL@1 (FIXED Ex. OCCU FIXED A P' LNS. OR 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 $ 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. ❑ 1 have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby TOTAL PERMIT FEE $ aLi UIi— 1VVIU0crli0u VCO UI mt: uumity UI mutte to enter upon the above- Toned propert for ' pection purposes. Date //-// —77 Signature f Permitee or Agent Receipt No. �, & D, a� White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By � Date %-- / (— % '7 SBudilitm permit expires tate COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS -7 County Center Drive—.=Uroville, California 95965 r Telephone: 534-4541 (� APPLICATION AND PERMIT autnonze representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. ate �5' natured Per Ae%or A t Rec No.fit-- White-D.P.W. — Yellow!ASseseor — PinK-Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By �, Date.-,/ �Prr.�permit expires Date BUILDING Owner '' SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace Contractor Total Valuation Mailing Address/, 3 2 k"(1 W Permit Fee Plan Checking Fee &/or Penalty r�jo T e hone o. / Permit Fee $ Building Address PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 '94 09q Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 A. P. No ,_ a Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 F4 <s Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans I Parcel Declaration Parcel Ma 60' R/W P Im r ments P Lawn sprinkler system 2.00 Bldg. Plans eed Parcel Ap oval Plans Approval Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 a Main service 100 AMP ORV OR LESS5.00 © r 2r X. o Main service EA. ADD'L too AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service OVER 600V 100 AMP OR LESS 25.00 Main service EA. ADD'L too AMP 1.00 NEW CONS. DWELING O OR ADDNST ( ACCLBLDGS.CCUP. &) 22sq tt NFW 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 's & Professions Code under the n me style of: o State of Calizap— Ex. OCCUp(OUTLETS OR FIXTURES) BAL 25 EX. QCCU FIXED APPLNS. OR P• ( OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 ��pp License No._ 02287-1 Y' Classification (91 Misc. Wiring 6.25 ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability . for Workmen's Compensation. zI have placed on file with the County of Butte a certificate of .Workmen's Compensation Insurance. that in the performance of the work for which this FJ permit is issued I shall not employ any person in any manner permit so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating - Cooling Ventilation Hood 2.00 Permit Fee $ $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby TOTAL PERMIT FEE $ s� 8 oc autnonze representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. ate �5' natured Per Ae%or A t Rec No.fit-- White-D.P.W. — Yellow!ASseseor — PinK-Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By �, Date.-,/ �Prr.�permit expires Date COUNTY OF BUTTE- — UEPArRTMENT OF PUBLIC WORKS 7 County Center Drive ­— br'iiville, California 95965 6 Telephone: 534,4541 7 / APPLICATION AND PERMIT ` uu oi_ revrescniaLvca UI tilt!LUUIILy UI CUHU TO enter upon the above-mentioned property for inspection purposes. X Date Z_121 4f'%Z Signature of Permitee or Agent Receipt No. �V6 % C/,/f� 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 OFAUBLIC WORKS BY�i Date moo`" " Beding per expires Date s BUILDING— Owner p ( SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace _ Contractor;, a•L� �.L , Total Valuation P.i l Mai I ing Address / �S Permit Fee Plan Checking Fee &/or Penal ty -���_ le hone No. Permit Fee Building Address///PLUMBING No. @ FEE PERMIT FILING FEE $3.00 — Each Trap 1.50 407- E 1,5_ k " 'I- q - Repair drainage or vent piping 1.50 on ng Verificaflon Ch,i C % Water piping 0— Each gas water heater or vent 1.50 /'_� _��� A. P. No — Zoni Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fe W a on FireDepta Fire Zone Use Permit Building sewer �-0�- C') EQA Parking Declaration Part I ap 60' R/W Improvements Lawn sprinkler system 2.00 Bld „� c'd iP �el Appra� Plans App Permit Fee $ 5' r ti NEW ADDITION ❑ ❑ UTILITIES OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 & V OR Main service 100 AMP ORSLESS 5.00 Main service EA. ADD'L too AMP 2.50 3TC^_ Single Family ❑ Duplex ❑ Mobil Home Others ❑ 60 0 OEAMP OR LESS 25.00 Main service 1 Main service EA. ADD'L too AMP 1.00 NEW CONST. DWELLING OCCUP. & OR ADDNS. ACC. BLOGS. ) 22sgft NEW CONSTMULTI-OUTLET NON-RESID R. ( BRANCH CIRCUITS) '2.50ea I 60� gAbBil NEW CON5TR. (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: f) Ex. Occup(OUTLETS OR FIXTURES) Q� BAL@1 04 p•(FIXED APP LNS. OR Ex. Occup.( OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 i Mobile Home Facilities 15.00 License No.-?I.7®Classification Misc. Wiring 6.25 ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ r2 , WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I to an certify that in the performance of the work for which this ermit is issued I shall not em p employ y person in any manner so as to become subject to the Workmen's Compensation Laws of California. MECHANICAL No.1 @ I FEEPERMIT FILING FEE J$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 .I, ,.I . TOTAL PERMIT FEE - — uu oi_ revrescniaLvca UI tilt!LUUIILy UI CUHU TO enter upon the above-mentioned property for inspection purposes. X Date Z_121 4f'%Z Signature of Permitee or Agent Receipt No. �V6 % C/,/f� 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 OFAUBLIC WORKS BY�i Date moo`" " Beding per expires Date s