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Home My WebLink About068-160-04768-16-47 I« - LEONARD CHOLLET ,1 I �2760 Quincy Rd, 0r��iillel�� 'Contr: J.E. Edwards, Oroville 4_PPrntit##4264-74E-(-e1e ser ch)SF -- - ---- ---- 68-16-47 2617-91B CHOLLET, L.M. 2760 Oro Quincy hwy, Oroville cont: Alladin Roofing (reroof/sf) e_ 30 -R l U68-160-047 PERMIT#95-0031 CHOLLET, LEONARD & GOLDINA 2760 ORO-QUINCY HWY, OROVILLE.�/ 9 s CONT: QUAILTY CONST. REPAIR FIRE DAMAGE & REPLACE FIREPLACE 068-160-047 PERMIT98-2 97 CHOLLET, L.M. �� 2760 Oro Quincy Hwy, OrQville Cont: De Air Company l � I New Furnace/SF 6 lC �i l . I wc5t,- -- �citn n -cc/ \N ct+C h at -f -c r C/o P cS C C'NT ,_W C A 1-1 I PI LI i'\') �3 I N C- PMS I Q_ - - r--_,,.�I __ � _ h't�Y`�-�°'-•�d:R,e,,,.g :P:.wr.-va w,�,a.. G'�Y�`�'T'-"�^t�.r�t�C�'4�C�"�'�'�Y,'.:,a.� N 068-160-047 }j,-PERMIT#98=2597 CHOLLET,`L.M. . , 2760 Oro Quincy Hwy,.Oroville Cont: De Air Company'- New F1l � urnace/SF. I s a, OFFICE COPY Address' GAS Da� Meter By ELECTRIC - Meter By Date { q6 ZP s h s a, OFFICE COPY Address' GAS Da� Meter By ELECTRIC - Meter By Date { q6 ZP s -' COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, Ealifornia 95965 - Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT ASSESSOR PARCEL PARCEL NUMBER, 468-160-047 ZONING AR UILDING PERMIT OWNER OT,OLLPT, L.M. TELEPHONE 533-4894 SO, FT, OCC. BUILDING VALUATION OWNERS MAILING ADDRESS 2760 ORO OTTTNCY, OROVILLF CONTRACTOR'S NAME DR AIR W,00 COMPANY TELEPHONE CONTRACTORS MAILING ADDL 10 B. 8??AT1TFR RIVER BLVD. CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan CheckingFee $ ^ T BUILDING ADDRESS 2760 ORO I,TTTN L lill Ener Plan Checking Fee $ Energy g $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation O Other O Describe Work: NRJ FTiRNAM Gas piping system 1 - 5 outlets 15.00 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE $ '-.1 ' ELECTRICAL PERMIT Fling Fee 20.00 Main Service ZDOAORLESS 23.00 LICENSED CONTRACTOR'S 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 the Business and Professions Code, and my license is in full force and effect./ License Class rr - -1 i.i Lic. No. -% �% k � � I J OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ [,as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ I am exempt under Sec. Business and Professions Code for this reason Main Service zooA To 1000A 46.00 NEW CONST. DWEWNG OCCUP. OR ADDNS. ( DWT=CG OCC. S° 3.5¢FT. NON.R°ESID MULTI.OUTLET 97.50 POWER APPARATUS 6 SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FDMRES 20 @' 00 BAL 50 Ex. Occup. °un.EE% AaID.°EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirinq 23.00 3.00 PERMIT FEE t !,a nn WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for�.which this permit is issued. El -'l have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier (I1 / C � t-- t -, Policy Number n 1 4'r f 2 III Policy (The above sections need not be completed 4 the permit is for work of a valuation of one hundred dollars ($100) or.less.) , ❑ 1 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 workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. Xr T gyp"" Date I /_ % — S Signature of Applicant - ❑ Owner ®`Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation , � PERMIT FEt S -1.9.00 - Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE :3. v TOTAL FEE $ HAZ. I D FEES IMP I FLOOD I CDF PARCEL PD HD ISSUE 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. By 11�n .i 1' < to -w__ Date /A A.• EXPIRES ON Al De to Receipt No. -7PERMIT WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT } t COUNTY OF BUTTE 4 BUILDING DIVISION DEPARTMENT -OF DEVELOPMENT �.ERVICES' 411 Main Street • Chico, CA • (530) 891-2751 7 County Center Drive • Oroville, CA • (530)'538-7541 CORRECTION NOTICE C 97)LI e -r V -2.� 7 OWNER PERMIT NO. A routine inspection indicates that the following violations of butte county Ordinances exist at the above address and should be corrected. Please notice this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact this office immediately. ?/2Z t o T S -r- d p S 5— "�'w if---: Date /off- In.s�ector' .' REV 10/92 q� I i,f COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BDIV ON 7 County Center Drive • Oroville, California 95965 • Telephone (5>30)538--7641 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 068-160-047 ZONING AP UILDING PERMIT OWNER C,HOLLFT, L.M. TELEPHONE 533--4894 SO. FT. OCC. BUILDING VALUATION .OWNERS MAILING ADDRESS 2760 OPO QUINCY , OROVILLF CONTRACTOR'S NAME DE ATR 01100 COZ' PANY TELEPHONE 534-8691 CONTRACTORS MAILING ADD 10 B. FrATNFP RIVER. FLVD . CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS P T 2750 ORO O .TInICY Ener Plan Checking Fee $ 9Y 9 $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF Lf Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: NEW FTIRNACF Gas piping system 1 - 5 outlets 15.00 15,00 Building sewer 15.00 Mobile Home ISI GI W1 920.00 PERMIT FEE S 35.00 ELECTRICAL PERMIT Filing Fee 20.00 Main Service 2o0A OR LESS 23.00 LICENSED CONTRACTOR'S 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 the Business and Professions Code, and my license is in full force and effect. License Class _� Z d Lic. No. �-/ 7 / OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason Main Service TG 46.00 NEW CONST. DWEWNG OCCUCUP. EE OR ADDNS. ( d ACC. BLDS. SO 3.50FT_ R61pT. MULTI.OUTLET 97,50 POWEPUS A SINGLER AOUTLETPARATCIR. Ex. Occup. OUTLET OR FDRURES B 20 1.00 @ .50 IED Ex. Occup. GuT rs R'ID°E 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wirin 23-0023.00 PERMIT FEE $ WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the ,erformance of the work for which this permit is issued. C9-1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' csation ir. uurrance ?�gier and policy number are: ompen Carrier E � / Policy Number 0 2 S L (The above sections need not be completed if the per(hit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 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 workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. X Date / / Signature of Applicant - ❑ OwneroC9'Gontractor ❑ Ageht An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. MECHANICAL PERMIT Filing Fee 20.00 Heating 15.00 Cooling Hood 6.50 Ventilation PERMIT FEE $ 35.00 Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE113.00 TOTAL FEE $ HAZ. 1 D FEES IMP I FLOOD I COF PARCEL Po HD I ISSUE This permit is hereby issued under the applicable of the Butte County Code and/or Resolutions indicated above for which fees have been By Date PERMIT EXP RES ON 1116 provisions to do work paid. BB /% 6 •O fe Receipt No. z -i 11-3 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT ._ cY'!7'• , •fi J t: -'z�_r..,. .";. % Y`i`:a�{'?;T; „rt `b?`Z'!:•�R Rr iw �;tr . ••ccv� a. a...;y. ,.1.a vrc.sx.�oto'; �1: 'ski 10- � `F '� - E . •'^)x 3•' i.s?i�'7"r� '-�. ..'if., y ;7; IJ�� 068-160-0471 '•"'PERMIT#95-0031 �GHOLL_ET, LEONARD &4GOLDI,NA ' 2760'ORO_QUINCY HWY.!O.ROVI,LLE CONT: QUAILTY CONST. REPAIR FIRE DAMAbE f-&jEPLACEDAMAGEFIREPLACE ycj1q /c '6/� �a a r COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. APPLICATION AND PERMIT 95- UC) ASESSOR PARCEL NUMBER Q6R — 16M47 ZONING AR BUILDING PERMIT OWNER TELEPHONE SQ. FT, OCC. BUILDING GGf1VA(ALAUhATION OWNER'S MAILING ADDRESS.x 2760 OPD QMDICY WV.00 CONTRACTOR'S NAME UAITY CONSTRUCTION TELEPHONE 534-6489 CONTRACTOR'S MAILING ADDRESS 559 OAKVAI.E Fireplace "All 000 CONSTRUCTION LENDER UNKNOWN Total Valuation $ 5 000.00 LENDER'S MAILING ADDRESS Filing Fee $ 20,00 Permit Fee $ 72.00 ARCHITECT OR ENGINEER LICENSE N0. Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS 9760 ORO 011INCY PERMIT FEE $ 92.00 ORMUE PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 Solar or heat pump water hede 23.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Water piping 15,00 Each gas water heater or ve 15.00 USE OF STRUCTURE SF l Duplex D Mobilehome ❑ Other SPECIFY Gas piping system 1 - 5 outl 15.00 Building sewer 15.00 Mobile Home S G W@20.00 TYPE OF WORK New D Addition ❑ Remodel ❑ Utilities D Installation ❑ Other ❑ Describe Work: 'IRE DAMAGE R17LACE FIREPLACE PERMI$ Contractor ELECTRICAL PERMIT Filing Fee 20.00 & SIDING 10111 LESS Main Service ( 00AORLES ) 23.00 Main Service ( 200A To 1000A ) 46.00 NEW CONST. DWELLING OCCUP. OR ADONS. ( & ACC. BLDS. ) 3.50 FT,gO, CONTRACTORS LICENSE LAW I de lare under penalty of perjury (check one) I am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions Qpde and my license is in full force adffect. License No. HOZ Classification ❑ 1, as the owner, or my employees with wages as th r sole,compensation, 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 contractors. (Sec 7044) ❑ 1 am exempt under Sec. Business and Professions Code forthis reason NEW CONST. MULTI -OUTLET NON-RESID. ( BRANCH CIRCUITS ) @7.50 POWER APPARATUS ( a SINGLE OUTLET CIR. )' Ex. Occup. ( OUTLET OR FIXTURES ) 20 @ 1.00 BAL. W Ex. Occup.FIXED APPLNS. OR (OUTLETS IRFSID.I EA. ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 • WORKER'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): Q -This permit is for $100.00 (valuation) or less. 1 have placed on file with the County of Butte Dept. of Development Services, Building Division 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 Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. PERMIT FEE $ 43. Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Contractor I certify that I have read this application and state thatthe above information is correct. I agree to comply to all Butte County Ordinances and California 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. 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 i "conquence of he granting of this permit. aze � Date_C7— Ci Signature of Applicant - El Owner FJ Contractor D gent % / / An OSHA permit is required for excavations over 5"0" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $ 135.00 HAZ D. FEES I IMP I FLOOD I COF PARCEL I PD I HD ISSUE This permit is hereby issued under the applicable of the Butte County Code and/or Resolutions indicated above for which fee have been 4"e,/_ PERMITEXPIRESON '[Date) provisions to do work paid. ate AIA4 Receipt No. 170961 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVIS N 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-75 PERMIT NO. APPLICATION AND PERMIT S - ASSESSOR PARCEL NUMBER 068 — 360-047 ZONING AP BUJ61NG PERMIT OWNER TELEPHONE SQ. FT- OCC. BUILDING VALUATION ST �0 • OO OWNER'S MAILING ADDRESS 760 CONTRACTOR'S NAME UALITY CONSTRUCTION TELEPHONE 534-6489 CONTRACTOR'S MAILING ADDRESS 999 TK Fireplace I "Al' 000 CONSTRUCTION LENDER UNKNOWN Total Valuation $ 5 000 • 00 LENDER'S MAILING ADDRESS Filing Fee $ 20,00 Permit Fee $ 72.00 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS PERMIT FEE $ 92.0f1 PLUMBING PERMIT Filing Fee 20.00 Each Trap 7,00 Solar or heat pump water heater 23.00 Water piping 15,00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Each gas water heater or vent 15.00 USE OF STRUCTURE SF Ck Duplex ❑ Mobilehome O Other SPECIFY Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G I W @20.00 TYPE OF WORK New ElAddition ElRemodel ❑ Utilities ❑ Installation CIOther ❑ Describework: FIRE DAMAGE REPLACE FIREPLACE PERMIT FEE 1 $ Contractor ELECTRICAL PERMIT Filing Fee 20.00 & SIDING Main ServicIII OR LESS e( 00A OR LESS ) 23.00 Main Service ( 200A TO ,000A ) 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( 8 ACC. BLDS. ) 3.50 FTSO., CONTRACTORS LICENSE LAW are under penalty of perjury (check one) I am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions de and my license is in full force and Affect. �'L License No. /OZ Classification -i O I, as the owner, 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) ❑ I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044) ❑ 1 am exempt under Sec. Business and Professions Code forthis reason NEW CONST. MULTI -OUTLET NON-RESID. ( BRANCH CIRCUITS ► @7.50 ( POWER APPARATUS ) BSINGLE OUTLET CIR. Ex. Occup. ( OUTLET OR FIXTURES ) B20 @ 1.5AL_00 Ex. Occu OUTLETS (RESID OR p' I OUTLETS IRESID.) EA. ) S.OD Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 2 WORKER'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): This permit is for $100.00 (valuation) or less. 1 have placed on file with the County of Butte Dept. of Development Services, Building Division 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 Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. PERMIT FEE $ 43 . 10 Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 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 Butte County Ordinances and California 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. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, • dgments, c ts, and expenses which may in any way accrue against said County i On uenc f he granting of this permit. X" V Date` Sign ture of Xpplicant - ❑ Owner Cl Contractor ❑ Agent An OSHA permit is required for excavations over 5"0" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ ocC CONST. TYPE TOTA EE $ 135.00 HAZ. O. FEES IMP FLOOD CDF PARCEL PD HD ISSUE This permit is hereby issued under of the Butte County Code and/or indicated ab a for which f e have PERMIT EXPIRES ON the applicable provisions Resolutions to do work been paid. ate AlIq Date) Receipt No.��q�� WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTYOF BUTTE - DEPARTMENTOF DEVELOPMENT SERVICES -BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 -TELEPHONE (916) 538-7541 OWNER Proposed Building Use PERMIT APPLICATION DATA SHEET Building Inspector A. P. No. 6�O�./�G Date At time of per ' pplication, I was advised the following data must be submitted prior to permit processing and/or issuance: 1. All items have been submitted. 2. Plot plans, 3/4 sets, signed by preparer of plans. 3. Complete plans, 3/4 sets, signed by preparer of plans. 4. Engineered plans and calcs, 3/4 sets, with wet signature on plans. 5. Hazardous Material Form. 6. Energy Design Compliance and supporting documentation. 7. Statement of Intent for Non -Heated and A/C Buildings. 8. Engineered truss details and layout in duplicate (required prior to plan check). 9. Mobilehome data and manufacturer's installation instructions, 2 sets. 10. Fees of $ 11. Impact fees as shown on attached schedule. 12. California Department of Forestry plan approval/fees. 13. Flood elevation letter (100 year flood) by California Engineer. 14. Sanitation and plot plan approval Health Department. 15. City of Chico plumbing permit. 16. Plot plan and business license approval from City of Biggs/Gridley. 17. Planning approval for (A) Use: (B) Parking: 18. Contact Land Development about (A) Improvements (B) Drainage. 19. Driveway permit (construction approval required prior to occupancy). 20. Pre -inspection for required. 21. Contractor's license information. (No., Name Style, Classification). 22. Certificate of Workmans Compensation Insurance. 23. Owner -Builder Verification (Given to owner , Mail to owner �. 24. Recorded copy of Agricultural Acknowledgement Statement. 25. Letter of signature authorization. 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. 27. Letter of intent on building use. 28. Mobilehome utility clearance. 29. Documentation of legal access. 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements. 31. Existing violations/expired permits. 32. Plan check list. 33. 34. When you issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver with inspector. Other Applicant Date EXPIRATION OF APPLICATION Applications for which a permit has not been issued, will expire by limitation one year after date of application. In order to renew action on an application after expiration, a new application; plans and fees will be required. FEE REFUNDS Refunds can only be made upon writtten request by the person who paid the fee. The request must be made within one year from the date of fee payment on permits not issued, and one yearfrom the date of permit issuancefor permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan checking fees for work plan checked and other department costs are not refundable. Original - Applicant _Y' �� r'1r-�''�r�,�.r,•'C'�+�.��..irk'""�`i.+,Fr'.^^L,fi'"rt4/nor...r+n*•+cr+trf}tw�,i..E',�t�i`�"'%r�r'"'Y"T`�'R�rr'^.Y,.;.��v%�►✓.it-/'vr(�..MY?r'a11,w.�7•y�<*�-+�...^t..�4�.k_.-,�,,,��. ,,*'r MYiwyc"'`'+"djAi R'itihn'(K rr -_. __COUNTY OF BUTTE - DEPARTMENT dF DIE�%ELOPMENT SERVICES - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIF60- IA95965 - TELEPHONE (916)538-7541' % , PERMIT APPLICATION DATA SHEET OWNER Proposed Building Use Building Inspector A. P. No. - "AGC �G Date At time of per it application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. All items have been submitted..... .............. . 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. ..................... Plot plans, 3/4 sets, signed by preparer of plans . .......................... Complete plans, 3/4 sets, signed by preparer of plans . ..................... . Engineered plans and calcs, 3/4 sets, with wet signature on plans . ............. Hazardous Material Form . ............................................ Energy Design Compliance and supporting documentation . .................. Statement of Intent for Non -Heated and A/C Buildings . ...................... Engineered truss details and layout in duplicate (required prior to plan check). .... Mobilehome data and manufacturer's installation instructions, 2 sets. ........... Feesof $......................................... Impact fees as shown on attached schedule . .............................. California Department of Forestry plan approval/fees. ....................... . Flood elevation letter (100 year flood) by California Engineer . .................. Sanitation and plot plan approval Health Department . ............ City of Chico plumbing permit . ......................................... Plot plan and business license approval from City of Biggs/Gridley. .............. Planning approval for (A) Use: (B) Parking: Contact Land Development about (A) Improvements (B) Drainage. .......... . Driveway permit (construction approval required prior to occupancy). Pre -inspection for required. .. to Building I nspecor (Date) Contractor's license information. (No., Name Style, Classification) . .............. Certificate of Workmans Compensation Insurance . .......................... Owner -Builder Verification (Given to owner , Mail to owner . .......... . Recorded copy of Agricultural Acknowledgement Statement . .................. Letter of signature authorization . ........................................ Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . Letter of intent on building use . ......................................... Mobilehome utility clearance . .......................................... Documentation of legal access . ..................... :.................. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... Existing violations/expired permits . ...................................... Plan check list . ..................................................... When you issue the permit, process as follows: Mail to owne . Mail to contractor. Telephone and hold for pickup at office. Deliver with inspector. Other Parcel Creation Acreage Applicant Date Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date " Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: y Contractor, designer, owner, was advised of above required data by _ phone -.mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone mail Counter by _ Date T z Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works OWNER: DATE o2 LOCATION: 21.0 r*"Yn - of , l ✓1 G -P UIQ IA I IQ A.P. CONTRACTOR: ZONING ---------------------------- DATE TO INSPECTOR PERMIT HISTORY:NONE AS FOLLOWS:_ TYPE OF OCCUPANCY FIELD - INFORMATION BUILDING USAGE: TENNANT: [� OCCUPIED D HAS ELECTRIC HAS,GAS HAS SANITATION FACILITIES [� HEATED -COOLED PERSON CONTACTED OTHER COMMENTS: X 0,:Q -C) Dlyv,�� ACTION RECOMMENDED: 0 ISSUE 0 HOLD FOR BY DATE t CDF / BCFD DAILY -INCIDENT LOG PAGE �; OF DAY/DATE FROM 080004 / f'�-. -C>?/ DAY/DATE TO 08 00 / �e�a - Q. CD-- ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ LOCATION: -�- a e- BAT. CAUSE: _ _ ENGINES: CDF BCFD CO# q Z OFFICER: V MISC.: INC # 4 yam& FIRE # ii&AMF (Jm -PPO a� TYP�5'"'Tj'��r LOCATION: e-' 76q-9 XJI �� ;�-�-f. (�!r.�.r.11(�.1 CAUSE: 57� , ENGINES: CDF DAMAGE: "MI0_ iT�.� SO / WT / ,( SAVED: `�_� OTHER EQUIP: /L ND USE: a r► on�%�'�/ _ ACRF/TYPF UYYNtK/ I tNAN I WRA R.P. � /, ..i ._i� -'`^ B.I. MISC.: Q -- +###+#*###++*+*#++++#++++++++++++++++++#++#+++++#++#+++*++#+#++# +++++++#++#+ INC # q113 I FIRE # NAME TYPE � (c` C1 REPORT TIME //-Z a- START TIME CONTROL TIME R.O. 7J Lt b7 STA. } t nreTIM1. v MISC.: INC # 9Li3`, FIRE # 17 NAME 1 '7,V411,W%1 �� TYPE REPORT TIME 1362— TART TIME/z//i4-CONTROL TIW;7 -�'i c� R.O. P--t-FarrtSTA. LOCATION: t)oy o,PARIL llx4D DV NAL tb/-t/t-t)its RAT_ LA CAUSE: ilR . =15ENGINES: CDF BCFD CO# OFFICER: DAMAGE: - = _ so WT DOZ CREW AA AT HC SAVED: - r ' OTHER.EOUIP: MEDICS LAND USE:.,t l- "Ec `� ACRE/TYPE TOTAL J n OWNER/TENANT WRA R.P. C .L .Q . B.I. MISC.: # # # # * * * * * A * * * * * * * # * * * * # * * * * * * * * * # * + + * * i i a � • a a a a a a a a a a a a a a a a a a a a a a a a a a . a . a .. a . ILI MISC.: Y COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT —P?R IT N0. q4 ASSESSOR PARCEL NUMBER 068-160-047 ZONING AR BUILDING PERMIT OWNER L.M. CHOLLET TELEPHONE 533-4894 SQ. FT. OCC. BUILDING VALUATION 29 29 @60 1740 OWNER'S MAILING ADDRESS ORO QUINCY HWY, OROVILLE CA 95966 CONTRACTOR'S NAME - ALLADIN ROOFING TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER NONE UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 10.00 Permit Fee $ 29..50 ARCHITECT OR ENGINEER NONE LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 2760 ORO QUINCY HWY OROVILLE Permit fee $ PLUMBING PERMIT Filing Fee 10.00 1 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[3 Duplex❑ Mobilehome❑ Other • SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I W 10.00ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other Describe work: REROOF W/COMP 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. El 1, 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) ontract- [� I, as the owner, am exclusively contracting with licensed contract- ors.(Sec. 7044) ors. ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.g OR ADONS. ACC. BLDGS. , /20sgft NEWCONSTR. ULTI.OUTLET NO N.R ESID BRANCH CIRCUITS 2.50 ea POWER APPARATUS &) SINGLE OUTLET CIR. Ex. Occu Occup(OUTLETS OR FIXTURES 2AL@30 .20@030 Ex. Occup. ou LETS (RESID )REA.) 1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. �yirin 9 15.00 Permit Fee $ 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. Contractor MECHANICAL PERMIT FiIingFee 10.00 Heating Cooling Hood 3.00 Ventilation permit Fee $ Contractor '• I certify that I have read this application andtstate 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. t 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 ---c f� Date 71YV.�'7 a� r 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 $ occ CONST TYPE - TOTAL FEE $ 39.50 HAz. I CUA I PARK SCHL I FLD I CDF I PAR I PD ) HD•ISS This permit is hereby issued a an the applicable to do sions of the Butte County. Code and/or resolutions to do work i dicated above for which ees have been aid. p DI R OF P B C WORKS B a8ce-7/21/91 P T EXPIRES Date 7/29/92 b Receipt No. WHITE-D.P.W., YELLOW-ASSE330R, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMITY. s —PERIII! IT NO. ASSESSOR PARCEL NUMBER 068-160-047 ZONING '* AR''v•- BUILDING PERMIT OWNER L.M. CH ET TELEPHONE 533-4894 SO. FT. OCC. BUILDING VALUATION 29 260 1740 O S LING ADDRESS 2760 ORO QUINCY HWY OROVILLE CA 9.5966 CONTRACTOR'SNAME ALLADIN ROOFING TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER NONE UNKNOWN Total Valuation is FilingFee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ 29.50 ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee $NONE Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 2760 ORO QUINCY HWY OROVILLE 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 pas water heater or vent 5.00 USE OF STRUCTURE SFFM Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S G W 10.00 ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other Ca Describe work: REROOF W/COMP 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. ❑ 1, 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) [ii- I, as the owner, am exclusively contracting with licensed contract- ors.(Sec. 7044) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.N OR ACDNS. (ACC. BLDGS. ,/22sgft NEW R. MULTI-OUT NON•RESID. BRANCH CIRCU ITS 2.50 ea POWER APPARATUS e (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20®50t 5ALe 30 FIXED Ex. Occup. OUTLETS P(RESID )REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring g 15.00 Permit Fee $ 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. Q'- 1 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. Contractor MECHANICAL PERMIT Filing Fee 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 Butte to enter upon the above-mentioned property for inspection purposes. to building construction, and hereby authorize representatives of the County ofLHAZ: 1 also agree to save, indemnify and keep harmless the County of Butte againstcuA all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. —• Date A % X - �LL�( .�'1 �1z� 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 $ CONST TYPE TOTAL FEE $ 39.50 PARK scHL FLD coF PAR PD y �o. Iss This permit is hereby issued under the applicable provi- sions or the Butte County. Code and/or resolutions to do ated above for which s have been paid. DIKIT, R OFYPJBC WORKS work;TEXPIRES B Date 7�2Q'�91 P Date .7.199199 Receipt No. 96871 WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Orovil►e. California 95965 - Telephone: 916/538-7541 APPLICATIQN AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER J a ZONIN fi BUILDING PERMIT OWN R �� F- e, TELEPHON 3 _A/ SQ. FT. OCC. BUILDING VA UATION OW ER'S AILING ADDRESS Q^Q 0, ' n e 1,(!) CO RACTOR'S NA Ej /1 TELEPHONE CONTRACTOR'S MAILING ADDRESS il Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee Energy Plan Checking Fee A$.. $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS ` Lu (/ ` 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,X Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mob le Home I S G FWT 0.00 ea TYPE OF WORK New ❑ Addition ❑ model ❑ Utilities stallation❑ Other Describe work: ✓' W Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service 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.SINGLE License No. Classification. F-1 1, 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.&, OR ACDNS. ACC. BLDGS. /z¢sgft NEW CONST R.RANCHUTLET NO N•R ESID BRANCH CIRC ITS 2.50 ea POWER APPARATUS s OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20@50C BALI 30¢ FIXED APPLNS. Ex. Occup. OUTLETS ((RESI 0.)REA•) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. byirin g 15.00 Permit Fee $ 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. Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling g Hood 3.00 Ventilation permit Fee $ LContractor 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 County in consequence of the granting of this permit. X 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 $ occ CONST TYPE _ - TOTAL FEE $ , S HAZ. CUA PARK scH� Flo coF PAR Po Ho. I IssuE This permit is hereby issued unaer sions or the Butte County. Code and/or work indicated above for which fees DIRECTOR OF PUBLIC By PERMIT EXPIRES Date the applicable provl- resolutions to do have been paid. WORKS Date Receipt No. 'NNITC-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD APPLICANT COUNTY OF BUTTE — DEPT,ARTMENT OF PUBLIC WORKS 7 County Center Drive — I Oroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT - .�,v...-v .�. V.�..+ �. � hull— .c vvunry v UU— tN cnlcI UJJU11 tnc above-mentioned property for inspection purposes. X Date Signature of Permitee 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. DIRECTOR OF PUBLIC WORKS BY Date- Building ate Building permit expires Date ..................:: "......'.. BUILDING 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 $ $ Building Address PLUMBING No.1 @ 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. N0. Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fees W. C. Sanitation FireDept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans Parcel60' Declaration Parcel Ma P R/W Im Improvements P Lawn sprinkler system 2.00 Bldg. Plans Rec'd Parcel Approval Plans Approval Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 - ,=>_ Main service incl. 1 meter Additional meters, each 1.00 Sub -panel (12 or less) (more than 12) Single Family EY Duplex ❑ Mobil Home ❑ Others ❑ Range, Cook -top or Oven 1.00 Water Heater or Space Heater 1.00 Light fixturesbol alo Receps., switches & fix outlets 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. FanorF.A. Furn. Motor 1.00 Evap. cooler, gar. disp. 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_^ ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ 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. 1:1 I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. El 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 @ FEEPERMIT 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 TOTAL PERMIT FEE $ - .�,v...-v .�. V.�..+ �. � hull— .c vvunry v UU— tN cnlcI UJJU11 tnc above-mentioned property for inspection purposes. X Date Signature of Permitee 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. DIRECTOR OF PUBLIC WORKS BY Date- Building ate Building permit expires Date ..................:: "......'.. C �- /� �. �� __ � L �� \_ r �. 7 e �. / `�= �/�O % = i �/ L Zl ��