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HomeMy WebLinkAbout068-120-052....... SAMUEL D. � LUCERO. /Z - $ Z 19 Glen eCircle-Dr., Oroville Permit 3405-73B,E;M �. (convert, garage _to bedroom)- 411193 ' L 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 . I 5Z, y t � r . I 5Z, y CN 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 . — q, • ^ 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) _y c,., } �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 ... 1 �' .j)'"' _^ • q` si 6-.,a ; ^},. f•+_�_; ��.i III 4. . M "I •.r s r l `, t } 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 - - ..:iC _t..;C: :tet' i �._ :'Y' •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 ? �' � `ti:F,.-.'l`:,...-,=..-w.,_ r ...--�..,.. � _..-.�.i "`�^�^.�-��,... .-.rM•_....+ .r,..-.-. � ..! , i:�-w'-- v v'..�j S✓-;, i", �,- _,._. ti- ..:.i - v' �� 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