HomeMy WebLinkAbout068-120-052.......
SAMUEL D. � LUCERO. /Z - $ Z
19 Glen eCircle-Dr., Oroville
Permit 3405-73B,E;M �.
(convert, garage _to bedroom)- 411193
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68-12-52
LEW _.OWNER.'
JIM ADAMS _ _ a��
Permit#479-88B(add walk th)ouj�d r 9in `
garage)SF
068-120-052 BP040661
., ADAMS, JAMES'& JUDITH
' � r al9,GLEN CIRCLE, OROVILLE_ , r
', 'CONT;`GEORGE ROOFING'S
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BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buttecounty.netidds
PERMIT NO.
BP040661
LICENSED CONTRACTORS 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
Issued Date: 03/10/2004 APN: 068-120-052-000
the Business and Professions Code, and my license is in full force and
effect. �/ �,
License Class : 6 —39 �i0License Number: 451
Site Address: 19 GLEN CIR ORO
Date: -- O _e Contractor:
Map Index: ,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Description: RE -ROOF (22.5 SQ)
Contractors' State License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, priory
.rte.,, �, ^ Owner: ADAMS JAMES J & JUDITH'A " )
to its issuance; --also requires the applicant for such permit to file'•a
..
s ' j ? >'ti_':I}'T },�, t
19 GLEN DR
signedstat�nept that he or she is licensed pursuant to thea Provisions ofd
.CIRCLE
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t () i#*,
the-C$ntractors State License Law (Chaptef'9 commencing with Section
«„y
Y �i
' OROVILLE,`CA i
7000),6f Drvysyon:3tiof'the Business and Professions Code) or that he. ".
4 y
w' I r t s ; s 95966 5[
she,id"tempt therefrorn:and the basis for Ithe, ,aallegedexemptlon., Any,
viplatio0 of"=Sect on 7031.5 by any applicant "for a 'permit sut?jects the
f , -�,��t y ( :, y"+•'?2sa" yCf:;:: f"
r ,.• .
applicant to a ciyahpenalty of not more than five hundred dollars ($500))
„
1 "" ' ' r1 f'
❑ 1, property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
„W
�" Code: "The Contractors `§tai L cense`., aw_does"not app'Py to an'
--ft
-A Iicant:-GEORGE•ROOFING'�
owner of property who builds. or improves thereon, and.who does.
such work himself dr herself or,through his.or her own employees,
provided that suchimprovements`are not intended or offered for
6810 LINCOLN BLVD
'sale 'If hdwever the building'oi ymproJements"are sold'wiihiri'one
OROVILLE CA 95966
year of completion, the owner -builder will have the burden of
'
-rk"yproving that he or.she did not build or'impFove for.the purpose of
(530) 533-6393
sale.).
0_,,,a I,a,�as,,,,ow„n,�er„ o�,,.,tlte.�P.SPP..?�Yr,.-afn.,,exclusiv_ely,,,�onttacting. with,,.
licensed contractors;tq;construct-lhe project (Sec. 7044, Business
,and l?, Contractors'• State License Law.does
not apply. to, an,owner of property who .builds or improves thereon;
Contractor: GEORGE ROOFING
_,,And who.contracts.:for`such projects with a;contractor(s) licensed
r ,,pursuant,to the Contractors State License
6810 LINCOLN BLVD
'
❑ x-I'am,Exempt under Article 3 of the Business and Professions Code
�, ••� ;; i , -, : , OROV.ILL• E; ICA '.95966
-(530)
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}
�f 533'-6393 t
Owner. , --
.. a
' P `s t c r S
License
1WORKERS' COMPENSATION DECLARATION ,
I hereby, affirm under penalty of perjury one of the following declarations {
qc
❑ .,I;have and;wdl: maintain a certificate of consent to self-in'sare fof'
z
wor,ers'•,compensation,:as provided. for by. Section 3700,of, the
-� — -_._.•.....a
Labor Code, for, the performance of.the' work for, which this permit
,architect:
ys;issued y
❑ I^_"hays"arid will m_intam.workers'compensaIion insufance; as'
"'^ '"'Engineer: -' '--'-'�'•"� �•^� ""' - -a-a' '-� ^��-^
required -by Secti6n.3700 the Labor.Code: for the performance of
the work for which this permit is issued: My workers'.
workers'. compensatioonn
ncpolicy-number nsurae`carrier and poliber are -. Irr
SIX,
,� i r
Carrier.
I Square Ft: 0 S F
Tota F.
_._._ _.__. _ .-, "•-
.,.,......
Pony c #: •" a-oe00s�Co
Valuation: $0.00
—' '- ---- . ---'--------.... _ .
certify
Census Code:
0 1 that in•the,performance, work.for which this permit is
issued;.I-shall;not employ, any: person, in; any manner.so;as:.to
beoome subject;to the workers'; compensation laws of California,
and tagree.,.that:.Jf,:;I, shoutd;;become;aubject :to, the,workers'
compensation provisions of Section 3700 of the Labor Code' I shall
.forthwith comply with th se provisions
..
`
-pT t<i q,
Date
...
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• q` si 6-.,a ;
^},. f•+_�_; ��.i III
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Apphcant�
i
"[
WARNING °-Failure toile use workers''compensatton coverage; is
z ' •
unlawful,`aiid shall'subject'an emplbyer'to criminal'pe'naltiesIarid -'one
hundredn,thousand"aollars:! ($100,000);x. in:'addition-i to"'. the=' cosh'of
m^
compensations damages as,proGided for .in Sectiorim3706;of'ihe Labor
1
code, interest and attorneys fees.,
',,. ��...
J%. 31751+0 5/I p/2>4
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•an. e .. ..—.... +. ...... ........ .. a.,»s,,, ,.. .,.a.«,.rt.r ...+a.".. ..,.r...e�.,w-
Edi.
•'-'CONSTRUCTION LENDING AGENCY s;.'•, i,;, hw.a.
This it is b i ue un er the applicable provisions of the Butte County Cade and/or
I hereby affirm that there is a construction lending agency for the •" .
p rformance of the work for which this permit is issued (Sec 3097 Civ.)
Res of ns t d i d' t v to which fees have been paid.
Name: ;
By Date:
✓
PERMIT EXPIRES
" _ ..
Address: -
ON:
(Date)
❑•T i I•hereby certify.that;the"use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage,
handling and.use of Hazardous materials. „
❑ Notification in accordance with Section 19827 5 ofCaliforma Health &=Safety Code is not applicable to the scheduled construction of this project.
[3Attached are copies of the required E P A notification forms r'
l..ti•4.., - 1•w t,r.. r•
I hereby -certify that l have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with ?
all county and state laws, relating to building construction. I acknowledge it unlawful to alter the substance of any official form or document of Butte County.''I hereby"...
authorize representatives of Butte /County to enter upon the atioo+ve myeentioned property for inspection purposes: , -
Print Name V hi9A/ C .�� i lY �0 K).A-L " Y3 to Signature
Date �/d D �E0�2CsC�dO%NG-
Qty
-` j 1 ❑' Owner s rrr ❑ Contractor "i, i EIAgent for Owner ❑ Agent for Contractor
':i�'^:.. !yn=aiClr•r. ir,.,.}': . _ .. .�. .r v .. ,. .:'i�' 'l ri; _....'','^ "
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
PERMIT NO.
BP o4cr.4I
DATE:-eelAPN:
O�8• I�O•G�1
ZONING:
OWNER'S LAST NAME:
OW R'S FIRST NAME:
PHONE:
STREET ADDRESS:
/47
FAX
CITY, ZIP: �. "
E-MAIL:
SITE ADDRESS:
CITY, ZIP:
NEAREST CROSS STREET:
TRACT/LOT it
APPLICANT NAME:
PHONE:
STREET ADDRESS:
FAX
CITY, ZIP:
E-MAIL:
CONTRACTOR NAME: !
PHONE:
STREET ADDRES
.
CRY. ZIP: �-
E-MAIL:
LICENSE NUMBER:LICENSE
s-- c43 s
TYPE:
c7 � 3
ARCHITECT/ENGINEER NAME:
PHONE:
STREET ADDRESS:
FAX.
CIN, ZIP:
LICENSE NUMBER:
E-MAIL:
DESCRIPTION OR SCOPE OF WORK:
❑ Structure Built without permits
❑ Proposed Change of Occupancy (note previous use)
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one year after the date of application. In order to renew
action on an application after expiration, a new application, plans and fees will be required.
REQUEST FOR REFUNDS
Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to
the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan
checked and other department costs are not refundable.
For office use only:
Notes:
Application Received by: Date: 5 �a.o•I`
Receipt number: :3qc5 I,4e�j Amount Received: $ 137 So
Master application 34-04
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i
Permit#479-88'
Jim Adams
" 19 Glen Circle, Oro
J COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
�P/E/RMMIIT NO.
ASSESSOR PARCEL NUMBER
Z r• NG:
BUILDING PERMIT
OWNER
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING, ADDRES/S ,
CONTRACTOR'SNAME -
TELEPHONE
p
1, 1 -
CONTRACTOR'S MAILING ADDRESS
Fireplace
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is C J
Filing Fee
$ 10,00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
r
LICENSE NO.
Plan Checking Fee
,$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MA'I LING ADDRESS
Penalty
$
BUILDING ADDRESS
1 �•'-i l ,i r /.e l I
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.SUBDIVISION
NAME PARCEL MAP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF,O Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
O.00ea
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] Other.®
Describe work: -r
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 600V OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification
I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ 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 CONST. DWELLING OCCUP.EI)/zQsgft
OR ADDNS. ACC. BLOGS.
NEW CONSTR. TI -OUTLET '2.50 ea
NON.RESID BRANCH CIRC ITS
POWER APPARATUS.1%)
(SINGLE OUTLET CIR. )
Ex. Occu zoa
Occup(OUTLETS OR FIXTURES eAL030
Ex. OCCUp. OUTLETS P(RESID IFIXED APLNS.KEA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare,u'nder penalty of perjury (check one):
Q" 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.
MECHANICAL PERMIT
Filing Fee 10.00
Heating
Cooling
Hood
3.00
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction., and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
1 also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County -in consequence of the granting of this permit.
X Z�/%%d,�
Date
Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee
$
Energy Inspection Fee $
TOTAL PERMIT FEE $ OJ
occu P.
CONST.TYPC
JSC.00L
I FLOOD
PARCEL
PD
ND
I ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOR OF PUBLIC
-7
By _
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date
Receipt No.
WHITE-D.P.W.. YELLOW -Ase CSSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT
V COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
' 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
PERMIT
ASSESSOR PARCEL NUMB Rl — ..
ZON.IN -
BUILDING PERMIT
OWNER__— .-
TELEPHONE
l
SQ. FT. OCC, BUILDING VALUATION
OWNER'S MAILING ADD p
CONTRACTOR'S NAME
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
Filing Fee
$ 10.00
LENDER'S MAILI G ADD SS
Permit Fee
$ Ov
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MXILING ADDRESS
Penalty
BUILDING ADDRESS
l
Permit fee
!$ $
-
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO..
SUBDIVISION NAME
PARCEL MAP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF/ Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S G W
0.00 ea
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other,
Describe work:(// /r,�L�Q�J /�GS�v�/
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service eooV OR LESS
100 AMP OR LESS
10.00
Main'servlce EA. ADO'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification
I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ 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 CONST. DWELLING OCCUP.a`
OR ADDNS. ( ACC. BLDGS. / , /20sgft
NEW CONSTR. I.OUTLET2,50 ea
NON.R E51D .BRA C CIRC S
POWER APPARATUS a
(SINGLE OUTLET CIR,
Ex. Occup(OUTLETS OR FIXTURES .200030
iAL030
Ex. Occup. OUTLETS P( RESID.)REA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
9
Permit Fee $
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declar n er 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.
MECHANICAL PERMIT
FiIingFee 10.00
Heating
Cooling
g
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
agai st said County in consequence of the granting of this permit. /
X Date �
Si 011.zure of Applie t — Owner ❑ Contractor ❑ Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
TOTAL PERMIT FEE $
Occup,
CONST.TYPEJ
SCHOOL
I FLOOD
PARCEL
I PI
ND
ssuE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
° DIRE OR OF PUBLIC
B
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
/�/ �'
Receipt No. Cid to
WHITE-D.P.W.. YELLOW-ASSESSO11, PINK -INSPECTOR. GOLDENROD -APPLICANT
COUNTY OF BUTTE - Department of Public Works
7 County Center D,riy j Oroville, CA 95965
OWNER -BUILDER VERIFICATION
Attention Property Owner:
Phone: 916
An 'owner -builder" building permit has been applied for in your name and bearing
your signature.
Please complete and return this information at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No building permit
will be issued until this verification is received.
1. I personally plan to provide the major labor and materials for construction of
the proposed property improvement (yes or no)
2. I (have/have not) signed an application for a building permit
for the proposed work.
3.
I have contracted with the following person (firm) to provide the proposed
construction:
Name
Address City
Phone Contractors License No.
4. I plan to provide portions of this work, but I have hired the following person
to coordinate, supervise, and provide the major.work:
Name
Address City
Phone Contractors License No.
5. I will provide some of the work but I have contracted (hired) the following
persons to provide the work indicated:
Name Addfess Phone Type of Work
Signed:
Property Owner
Social Security Nu ber '
Date
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
19832 of the California Health and Safety Code.
This verification must be completed and returned to our office before we are per-
mitted to issue the permit.
r
PERMIT NUMBER - B 34051?13B,E,M
P
[ E
PERMIT EXPIRES [ O - a �L `_7
OWNER Samuel D. Lucero
CONTR:
Owner
LOCATION (A.P. 34-06-52'
19 Glen Cirr6le Dr., Oroville
Forms
Fireplace
Lath & Plaster
Found. Vents
Rough Elec.
Kitchen Vent
Sanitation & Water
BUILDING
Cert. of Occup.
Final
DATE REMARKS OR CORRECTIONS
COUNTY OF BUTTE
Department of Public Works
BUILDING INSPECTIfON RECORD
Zoning _
Setback
Foundation _
-Piers & Girders
Rgh. Plumbing
Bond Beam
Rein. Steel
Gas Piping & Test
Framing
-7 Plmg. Topout
Wtr. Htr.
Furnace
Firewall
Garage Vents
ELECTRIC
GAS
Temporary
Temporary
Final
Final
Forms
Fireplace
Lath & Plaster
Found. Vents
Rough Elec.
Kitchen Vent
Sanitation & Water
BUILDING
Cert. of Occup.
Final
DATE REMARKS OR CORRECTIONS
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS %e3
7 County Center Drive — Oroville, California 95965
Telephone; 534-45j1
APPLICATION AND PERMIT
`
BUILDING
Owner �� e-
SQ. FT. OCC. BUILDING VALUATION
Mailing Address L ��h �6
J /
e
Telephone No.
�
Fireplace
Contractor
Total Valuation
Mailing Address
Permit Fee
Plan Checking Fee &/or Penalty
Telephone No.
Permit Fee
$
� /
Building Address 47G� G •—•
PLUMBING
No.
@
FEE
PERMIT FILING FEE $2.00
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. �_ D _ ��
Zoning & Planning
Gas piping system 1 - 5 outlets
1.50
Each additional outlet .30
Fe
a i a d
Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
Parking Parcel
Plans Declaration
parcel Ma P
60' R/W
provements
Improvements
Lawn sprinkler system 2.00
4___Permit
Bldg. Plans Recd
Parcel Approval Plans Approval
Fee
$
$
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER —
ELECTRICAL
No.
@
FEE
PERMIT FILING FEE $3.00
��-
,,,,,.,,/,Main
service incl. 1 meter
Additional meters, each
1.00
Single Family Duplex ❑ Mobil Home ❑ Others ❑
Sub -panel (12 or less) (more than 12)
Range, Cook -top or Oven 1.00
Water Heater or Space Heater
1.00
Light fixtures balP2o
r�'D
Ragps., sw' es & fixtlets
pp
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:
Hood, Ex. Fan or F.A. Furn. Motor
1.00
Evap. cooler, gar. lisp. or D.W. 1.00
Air conditioner or heat pump
Water pump
Mobil Home Facilities 5.00
Temp. Power Pole 5.00
License No. Classification
Misc. wiring
Ell -am exempt from the Contractors License Laws of the State of California.
Permit Fee
$
$77 �Q
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
W men'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.1
@ I
FEEPERMIT
FILING FEE J$3.00
Heating
T �r
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
$
authorze representatives of the county or Butte to enter upon the
above mentioned property for inspection purposes.
X b1l aA 144 Date
S'gnatur f
f Permiteee_, or Agent /_
Receipt No. Z/ 2 � [� _
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
Building permit expires