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Home My WebLink About069-220-07329 Skipper Ct., lot 265, Kl#3, Orpvill ermit 137 3-76P,E(util.,MH) < ELEC.-7/1 . S GAS 1- SUPPO T S RUCTURE REQ. /V/ -- COMPACTION TEST REQ.- /ro contr:Carneros Mobile. Transport, Nana Permit #4115-76MHI Issued 69- zz-73' Permit 4432-76B CONTR: Holmes MH Serv.,Bango (carport awning & cov.deck/M ) ° ��I�N �N � �� 41 J_ - 745?� PERMIT NO. 3793-76P;E /y PERMIT•EXPIRES u OWNER Oro Ridge Properties CONTR. owner LOCATION (A.P. 34-74-16 29 Skipper Ct., lot 265, KR#3, OiWille 1 t I—L\A r Pol G Elec. erv. G&E Zerv.G&E1-7 JO l\ � I (l 4A ake) (Signatur COUNTY -OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING Setback 3-7 Firewall Soil Piping Forms Parapets 1st Floor Main Bldg. Restroom Finish 2nd Floor Footings Windows 3rd Floor Stemwall Sidino To out Slab Roof Sheathing Water Piping` 11 Piers Roofing Sewer Garage Fdn. Vents Fixtures Footings Stemwa l l Garage Vents Insulation Water Htr. Heaters Slab Carport Footings Prov. for physically handica ed Conformance of ex. structure Appliances Gas Piping &Test Temp. Gas Slab Final Sanitation Patio FIREPLACE Final Footings Footing ELECTRICAL Masonry Walls Throat Rou h —/ 3 -7 Reinf. Steel Final Fixtures Bond Beam FIRE SPRINKLERS Motors Framing Test Water Htr. Stucco Final Sub anels Mesh MECHANICAL Grd. Fault Prot. Scratch Heating Service Brown Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation Permanent Door Closer Final Final DATE REMARKS OR CORRECTIONS (NOTE: An entry must be made on this form each time you visit the job site.) COUNTY OF BUTTE DEPARTMENT OF PUBL,.IC WORKS 7 COUNTY CENTER DRIVE OROVILLE, CALIF. - 534-4541 CERTIFICATE -OF OCCUPANCY This mobilehome has been installed in accordance with the requirements of the California Administrative Code, Title 25, Chapter 51 under permit number for the following location: Owner -� K i%r a !� n �7✓/ Owner's Address 5 c Z -Si Mobilehome Mfg. LG' Model — — Year -74-- Insignia No.(,O 66,7 Serial No. It is hereby certified for occupancy at the above described location and may be occupied. Director of Public Works Date _ �(i - %�m- By C -i //".,L THIS CERTIFICATE IS VOID WHE MOBILEHOME IS RELOCATED 9. Electrical A. Is service large enough to provide adequate amperage to mobilehome (must equal rating of mobilehome with a minimum of lamp) and other facilities on lot, i.e,, water pumps, garage, cabana, etc.? .Yes No B. Is there proper clearances around panels? Yes °' No C. Is power supply cord or feeder assembly properly fused? Yes_+rO__ D. Is continuity test satisfactory as per the following procedure? Yes `'—No_J 1. De -energize electrical wiring system of the mobilehome at the pedestal. 2. Make sure that the power supply cord or feeder assembly conductors, including neutral conductor, have been disconnected. 3. Switch all breakers and switches in the mobilehome to the "on" position. 4. Connect one lead of a test. instrument to the mobilehome grounding conductor and apply the. other lead to each. mo'oi ieii `ne supply conductor, including neutral. 5. All non-current., carrying metal parts of the mobilehome (aluminum siding, gas line, water line),. including fixtures•,and'appliances, shall be tested for continuity from such equipment and the grounding conductor.. 6. Upon completion of the above procedure, the power supply cord or feeder.assembly conductors. shall be connected to the site service equipment. A further continuity test 'shall then be made between the grounding electrode and the chassis of the mobilehome. Upon satisfactory completion of the electrical tests, the lot or site service equipment may be approved for energizing. 10. Is job card signed by Health Department for hater and sanitation? 11. If everything okay, sign off card and tag services. MOBILEHOME DATA Manufacturer and/or Names tyle Vrd Length Width Vehicle,Serial No. State Identification No.00oS617. DOOR&R Additional.Information or Comments: MOBILEHOME INSTALLATION' INSPECTION CHECK LIST 1: Is the mobilehome located wit equired separation from lot lines and buildings and generally conform to plot plan? Yes` ff No 2. Does the mobilehome have required clearances above ground? (Sec. 5085) Yep` No 3. Are footings and supports properly sized, spaced, and braced as per approved plans? (Note possible variation at 'spring shackles.) (Sec. 5082 & 5083) Yes A"No 4. Is .the mobilehome level? (Sec. 5088) Yes 0""' No� 5. If more than a single unit, are crossover connections properly installed? (Sec. 5088) Yes No 6. Water A. Is fj�xible connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes No B. Test - Does water piping withstand working pressure or.50 lbs, air test? Yes No C. Backflow - If coach is not State of California approved, does station have backflow device and pressure -relief valve? Yes-/ NO ---4) 7. Wastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes t --No B. Does it have minimum 4' per foot slope and is it properly supported? Yes "'--No 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 coach is not State of.California approved, does station have required trap and vent? Yes No �f1J 8. Gas Piping and Gas Vents A. Co ector - Is mobilehome connected to the gas supply with'an approved 3/4" minimum mobil me Is not more than 6 ft. long? - Note: All pipi is to be at least as large as a mobilehome gas line inlet without reductions o r than the mobilehome connector. No B. Test OK as per follow procedure? Yes No 1. Open all appliance co ctor valves. 2. Shut off appliance burner and of valves. 3. Air test with manometer 10"-14" wa column, or test with slope gauge (minimum 6oz.-maximum 8 oz.) ibrated in tenth p nd increments. Test for 10 min. without drop. 4. Connect gas eter to mobilehome with connector, turn as, test connections with soapy war. C. Are al appliance vents properly installed? Yes No. COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — _0rov!IIeLCalifornia 95965 Telephone: 534-4541 APPLICATION'AND PERMIT -.y - a,u. av -1 — uVvn auc above-mentioned proper t r inspection purposes. t Date1/11,4,17 Sign re of Permitee�or 41 Receipt No. White-D.P.W. – Yellow -Assessor – Pink -I Spector – 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 p id. DIRECTOR OF PUBLIC WORKS By —Z'I —% to UIIding permit expires Date a 7-7 -7 BUILDING Owner ORO RIDGE PROPERTIES, INC. SQ. FT. OCC. BUILDING VALUATION Mailing Address ' Telephone No. Fireplace Contractor Carneros Mobile Transport Total Valuation Mailing Address 1290 El Capitan Permit FeePlan Checking Fee&/or Penalty Napa, California 94558 Telephone No. 707 252-2411 Permit Fee $ Building Address PLUMBING No. @ FEE PERMIT FILING FEE $3.00 29 Skipper Court Each Trap 1.50 Oroville California 95965 Repair drainage or vent piping 1.50 /c� � Water piping 1.50 Each gas water heater or vent 1.50 A. P. No. 34-74-16Gas Zoning & Planning piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fqk W . .S FireDept. FireZone Use Permit Building sewer 5.00 EQA IParking Plans I Parcel Declaration parcel Ma P 60' R/W Im rovements P Lawn sprinkler system 2.00 Bldg. Pli s Recd Parcel Aprovol Plans provaI Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER [X ELECTRICAL No.1 @ FEE PERMIT FILING FEE $3.00 service 600v OR LESS 100 AMP OR LESS 5•Q0 Installation 3 74,Main Main service EA. ADD•L 100 AMP 2,50 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service 100 OVEAMP OR LESS 25.00 Main service EA, ADD•L 100 AMP 1.00 NEW OR ADDNST ( ADWECCLBLDGSCCUP. &) 2¢syft NEW CONSTR. MULTI -OUTLET NON-RESID, ( BRANCH CIRCUITS) 12.50ea NE1Y CONSTR. (POWER APPARATUS & NON.RE51D. 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 s tyle of: Carneros Mobile Transport Ex. Occup(OUTLETS OR FIXTURES)Pte'' BAL@1 (( FIXED APPLNS, OR Ex. Occup. P• l OUTLETS (RESID,) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. 259158Misc. Classification C-61 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. I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issuedI shall not em P . employ y an y person in any manner so as to become subject to the Workmen's Compensation Laws of California. 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 MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ Mobile Home Installation $ 30.00 TOTAL PERMIT FEE $ 30 00 -.y - a,u. av -1 — uVvn auc above-mentioned proper t r inspection purposes. t Date1/11,4,17 Sign re of Permitee�or 41 Receipt No. White-D.P.W. – Yellow -Assessor – Pink -I Spector – 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 p id. DIRECTOR OF PUBLIC WORKS By —Z'I —% to UIIding permit expires Date a 7-7 -7 COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - "Uroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT vricov iia„vea vi me u0unly ul ouue iu enter upon me above-mentioned property for inspection purposes. X �i,;Zo i Date Signature of Py, P tee or Agent Receipt No. _/ L , `/ 3J 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. ')'- RECTOR OF P LIC WORKS By Date7 ! L•- 7 Sa ding permit expires Date 7—,( l - %7 BUILDING Owner SQ. FT. OCC. BUILDING VALUATION Mailing Address�� Z _J�/G Telene No. ��fL Fireplace Contractor Total Valuation INJ Mailing Address Permit Fee Plan Checking Fee&/or Penalty Telephone No. Permit Fee Building Address GD Zlc�t_- -.;?, PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 CfO_ 2?" R.Q�/y L c c Each Trap 1.50 Repair drainage or vent piping 1.50 67- lk. 1;�,_W 3 iZon?ng Verifica#ion 0fii Water piping I=E& ZQ. OD I Each gas water heater or vent 1.50 A. P. No. ,�4� 7St' �� Zo Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 A/ Fees W.C. n Fire Dept. Fire Zone Use Permit Building sewer 10.0o EQA PPlans Declark I a anon Parce 3M p 60' R/W Improvements Lawn sprinkler system 2.00 Bldg. Plane Rec� �4 ParSI Approval PI pproval Permit Fee $ a.3:O0 $ NEWADDITION ❑ ❑ UTILITIES OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3,00 3.00 Main service 600V OR 100 AMP ORLESS5.00 0 Main service EA. ADD'L 100 AMP 2.50 C Single Family ❑ Duplex ❑ Mobil Home fZ Others ❑ Main service 1100EAMP OR LESS 25.00 Main service EA. ADD -1- 100 AMP 1.00 1000 SQ. FT. MINIMUM NEW OR ADDNST ( DWELLINGOCCUP. &\ 22sq ft BLDG S. NEW CONSTR. ( BRANCH CIRCUITS) 2.50ea NON.RESID, .SVR FOR M^OfL� 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: �� S Ex. Occup(OUTLETS OR FIXTURES)50 @25Q BAL@104 FIXED APLNS. Ex. Occup. (OUTLETS P(RESID )REA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 S,0 License No. Classification Misc. Wiring 6.25 10 1 am exempt from the Contractors License Laws of the State of California. Permit Fee $ j j'(U $ 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. �Ihave placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. I certify that in the performance of the work for which this permit is issued I shall not em p to an employ y 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 L PERMIT FEE $ s.0 vricov iia„vea vi me u0unly ul ouue iu enter upon me above-mentioned property for inspection purposes. X �i,;Zo i Date Signature of Py, P tee or Agent Receipt No. _/ L , `/ 3J 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. ')'- RECTOR OF P LIC WORKS By Date7 ! L•- 7 Sa ding permit expires Date 7—,( l - %7 MOBILEHOME SUPPORT DATA Mobilehome Mfr. Royal Lancer (Lancer) - Setup Model No. 2-Q Year 1976 Width 24 (ft.) Length .. 64 (ft:)-Expando Size ft.x ft. ` (Draw support details below) . On all mobilehomei§-.manufactured after October 7, 1973, furnish manufacturer's installation manual and structural setup sheets :(if. not on file with the County of Butte). Sin le - Footings -(check.one FEE,/ 1. Wood :either j' pressure treated ox Center Center Sup ort fdn.•-grade.:: Support Footing Sizes Locations (in.) 2. Concrete pad. i /� 3.: Other, `specify f �. in. _ Supports (check one 0 1. Concrete ;)lock Zjr e.� 24 x 3 ;/ / 2. Concrete piers .ft n1 in.:)- in.-) .. - . . ...... ...... 3. Steel piers ' / / .4...Other, specify �.. TypicaSupport WE j 12 X 30` Footing -Size - v ' 24 x 30 in. in.) ft:) in. (in.) (in.) ......................... Max. Pier':...- - 5. _ 6 :•. Spacing - a 24 30 in. ft. in.) (in.) (in.) - r 1 0 Max. - f - Overhang , IIII in. *If center piers are other than drawn above,, BUTTE COUNTY draw in locations, spacing, and dimensions. BUILDING 'DEPARTMENT APPROVED 3 BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive; Oroville, CA. PHONE: 534-4541 MOBILEHOME INSTALLATION SHEET 1. Owner's name: ORO RIDGE PROPERTIES, INC. ' 2. Installer's name: Carneros Mobile Transport 3. Is the site currently under permit? Yes / x/ No —� � (If yes, furnish permit number 7�5--7) OR Is the site an existing site? Yes / / No %z / (If --yes, furnish two ( 2) plot plans.) 4. Will the mobilehome be located at least 5 ft. away from septic tank and leach fields and, clear of all setbacks and easements? Yes /X / No (If no, clarify 5. What is the mobilehome electrical rating? ----------------------- 200 Amps 6. What.is the mobilehome site service rating? --------------------- 200 Amps 7. What is the mobilehome site circuit breaker rating? ------------- 200 Amps 8. Is there any other electric load to be served by the mobilehome siteservice? --------------------------------------------------- (If yes-, identify the load and size: (Load) 9. What -is the mobilehome site gas pipe size? ---------------------- Yes / / No / -0 (Amps) -0-- 10. What is the type of gas service?- ----------------------------- Natural / / LPG 11. What is the gas pipe length from meter or tank to the mobilehome? -0- (ft.) 12. What is the mobilehome gas demand? ------------------------------ ^0- (BTU) (This information not required'if pipe length -less than 6 ft. on natural gas or less ,than 50 ft. on -LPG.) NOTE:—ATI Materials & Workmanship S{; It Be. m Accordance with RQcosnired Gond Prnc+ices an*! ' of a quality prescr;ke4 for +he SDeclfied use in the, Uniform Buildinq, Plurnhinq & Machanica! Codes and ..,, . +he National Electrical Code. 12 D s� r. -8�►.r - I 2.9 LOT LOT 2G5 UNIT 3 This � set of plans �e�s MUST be ke ton the job. at all times and it is unlawful to ma c® any changes or alterations on same withdut wri en pertnisson from the Department of Public Wor s, County of Butte. The Setback s '4 e 5 ft. from the side property line nd 50 f+. from the centerline of the ad, permitting a maximum of a 2 ft. ave overhang: SIAL C n i�rM,r�at3)93- lee i\4 1 Allutility connections shall be I . to ted within 4 ft. outside the rear third section of the mobile home � one eft (road) side of the mobile a ora 5t 4'- . L3P�� Loia b S -- BUTTE BUTTE COUNTY BUILDING DEPARTMENT � APPROVED /Z - 27_ ,S 3. p 3 o W A\ o .< <i m s� r. -8�►.r - I 2.9 LOT LOT 2G5 UNIT 3 This � set of plans �e�s MUST be ke ton the job. at all times and it is unlawful to ma c® any changes or alterations on same withdut wri en pertnisson from the Department of Public Wor s, County of Butte. The Setback s '4 e 5 ft. from the side property line nd 50 f+. from the centerline of the ad, permitting a maximum of a 2 ft. ave overhang: SIAL C n i�rM,r�at3)93- lee i\4 1 Allutility connections shall be I . to ted within 4 ft. outside the rear third section of the mobile home � one eft (road) side of the mobile a ora 5t 4'- . L3P�� Loia b S -- BUTTE BUTTE COUNTY BUILDING DEPARTMENT � APPROVED /Z - 27_ ,S a f PERMIT NO. 4432-76B PERMIT EXPIRES OWNER Oro -Ridge Properties CONTR. Holmes MH Service, Bangor LOCATION (A.P. 34-74716 29 Skipper Ct., Oroville Temp. Power ole Called &E Temp. El . Serv. Call PG&E Temp. as Serv. C lled PG&E NALED iii -11 - (Date� (Signatute) ` - 7 COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING Setback _ j — 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 Garage Vents Water Htr. Stemwall Insulation Heaters Slab Carport Footings Prov. for physically handica ed ' Conformance of ex. structure Appliances Gas Piping &Test Temp. Gas Slab Final Sanitation Patio FIREPLACE Final Footings !3—/Y— Footing ELECTRICAL Masonry Walls Throat Rou h Reinf. Steel Final FiYtirrnc UVI{u Motors Framin-q Test Water Htr. Stucco Final Subpanels Mesh MECHANICAL Grd. Fault Prot. Scratch Heating Service Brown Cooling Temp. Pole Finish Ducts Under round Interior Lath Ventilation Permanent Door Closer Final Final DATE REMARKS OR CORRECTIONS r!I mer JO / /? Ah /rte �rS o 7-1 �1.. `/ 76 k-1 G -w- 0 �os /- o)e 10-//-7G (NOTE: An entry -must be made on this form each time you visit the job site.) 7 COUNTY OF BUTTE- — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Urovihe, California 95965 " Telephone: 534-4541 APPLICATION AND PERMIT u J "atIVeS VI UIC \,UUIILy UI Butte IU enter upon me above-mentioned property for ins ection purposes. L�- JJ. . X atDate `� _�� S. ure of Permitee or �Agent i (� Receipt No. / / ge9V 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%UBLIC WORKS BY Date- B riding permit expires Date Y-,9-7-? BUILDING Owner SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace Contractor/X;V--/ 1F]5 0WO/3, L �� Total Valuation ?3000 Mailing Address . a i ISX /�%� Permit Fee 2-ya a Plan Checking Fee&/or Penalty /► A/60/L07,97z Telephone No. 13 y Permit Fee $ ✓L as 2 V Building Address s S'��PyrJ� ,�T �� PLUMBING No. @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 oC / Repair drainage or vent piping 1.50 Water piping 1.50 I- o *26- - 4,nA Ira Each gas water heater or vent 1.50 3 `1 7 / / , A. P. No. `7 ! b Zoning 8 Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fe =24i /Q& Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration Parcel Ma P 60' R/W Improvements provements Lawn sprinkler system 2.00 Bldg. Plans Recd vl '� Parcel Approval � � Pld4rs�pproval Permit Fee $ NEW ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 5--0,0,..- E �- Main service 600V OR LESS 100 AMP OR LESS 5.00 Main service EA. ADD'L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service100 VEAMP OR LESS 25.00 Main service EA. ADD'L foo AMP 1.00 NEW CONST. OR ADDNS. ( ACCLBLDGLING OCCUP. &) 22sgft NEW CONSTR MULTI -OUTLET NON-RESID, ( BRANCH CIRCUITS) 12.50ea 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: / �> lJg9L_I Z:yS M O B1 LE .CY-0%h Ex. Occup(OUTLETS OR FIXTURES)50 @25¢ BAL@1 Ex. Occu P•(FIXED APPLNS. OR OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No.3_ Classification �_ 1 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. 1:1 I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. fes^ I certify that in the performance of the work for which this 613-Lpermit is issued I shall not employ any person in any manner so as to become subject to the Workmen's Compensation Laws of California. 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 MECHANICAL No.1 @ FEEPERMIT FILING FEE J$3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ TOTAL PERMIT FEE Tly 0 u J "atIVeS VI UIC \,UUIILy UI Butte IU enter upon me above-mentioned property for ins ection purposes. L�- JJ. . X atDate `� _�� S. ure of Permitee or �Agent i (� Receipt No. / / ge9V 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%UBLIC WORKS BY Date- B riding permit expires Date Y-,9-7-? COUNTY' OF BUTTE Oroville, California GENERAL CLAIM CLAIMANT: CUSTOM BUILDING BY GEORGE — GEORGE SUMMIT ADDRESS: _ PO BOX 5444 CITY & STATE: OROVILLE, CA 95966-5444 DATE OF CLAIM: 9/14/98 SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES IMPORTANT.• SEE INSTRUCTIONS ON RFVFRCF cine DATE DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY)v AMOUNNTT CLERICAL ERROR, PERMIT NOT REQUIRED. (A.P. #069-220-073, B.P. — . TOTAL AMOUNT PAID ON THIS PERMIT ..................... $43.00 TOTAL AMOUNT TO BE REFUNDED .........................$43.00 TOTAL $43. 0. I, the undersigned, declare under penalty of perjury that the services or articles claimed he a been erformed o delive ed, and that this claim i and correct assttated. . I Dated this J day of, 19 °%�at _ Calif. ture of CI)imant true 1, the undersigned, hereby certify that, to the best of my knowledge, the services or articles 'fled above h be performed or delivered and that there is a Budget Appropriation [ I or Specific Board Approval [ I (Check one) for the a Dated this 14TH day of SEPT ; 199$at OROVILLE Calif. Depa ent Head or Authorized Deputy Dept. Code 440-002 Exp. Code 4210500 PAYABLE FROM CONST UCTION PERMITS Dept. Code Exp. Code PAYABLE FROM Dept Code Exp. Code PAYABLE FROM DO NOT WRITE BELOW THIS LINE - AUDITOR'S USE ONLY FUND FUND FUND DEPT. & SUB. PROJ. SUB. OBJ. CLAIM NO. INV. NO. INV. DATE ENCUMB. GROSS AMT. FOR BUILDING DIVISION USE: Receipt Information: Number: _a4 q Date: 2LglIq F Issued To: Amount: Fees Retained: Processing Fee: $ Bldg Filing Fee: $ Plbg Filing Fee: $ Elec Filing Fee: $ Mech Filing Fee: $ Energy P/C Fee: $ .q� Plan Check Fee: $ Inspection Fee: $ SRA Fee: $ Total Amount Retained $ TOTAL REFUND DUE $ .7� REFUND CLAIM APPLICATION CLAIMANT'S NAME MAILING ADDRESS ASSESSOR PARCEL # RECEIPT NUMBER(S) 011 - Request a refund of fges paid on the to -�. 11 ll_... receipt numb r(s) for the following reasons: + a.4 • . 1 Please refund any applicable fees in the following categories: (Check those categories which you wish to have refunded.) ( ) Building Permit Fees ( ) Sheriff Fees ( ) SRA Fees (CDF Fire Planning) Disposition of Plans: ( ) Plans returned to me at counter ( ) Urban Area Fees • 4` ( ) Please mail plans to me at above address. ( ) . Please dispose of plans. SIGNATURE F• - PLEASE DATE AND SIGN THE ATTACHED COUNTY OF BUTTE GENERAL CLAIM FORM. DO NOT COMPLETE ANY OTHER INFORMATION ON THAT FORM. COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISIO 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-75^ /� v N0. (Rev. 12/96) APPLIGATI®N AND PERMIT ASSESSOR PARCEL NUMBER 069-22-0-073 ZONING RT -1 BUILDING PERMIT OWNER TESTER STNE. TELEPHONE SO. FT. OCC. BUILDING VALUATION 15 SQ 900 . OWNERS MAILING ADDRESS CONTRACTOR'S NAME TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation Is ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ 23.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADD S 29 IPPER COURT, OROVILLE Energy Plan Checking Fee $ $ PERMIT FEE _ 14 LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT -on Fling Fee 20.00 USEOFSTRUCTURE SF IR Duplex ❑ Mobilehome O Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 15.00 TYPE OF WORK New ❑ Addition O Remodel O Utilities ❑ Installation O Other X3 Describe Work: REROOF/COMP Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE S ELECTRICAL PERMIT Fling Fee 20.00 600VOR LE Main Service 200A 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 #41 force and effect.i License Class Lic. No. O� 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. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. O 1 am exempt under Sec. Business and Professions Code for this reason 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. O 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' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed if the permit 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 worker ' compens provisions of secti n 3700 of the Labor Code, I shall Jrthw comply ith th se provisions. r XDate �� l a f p Ica - ❑ bkner "Contractor ❑ Agent An OSHA permit is req d for cavations over 5'0" deep and demolition or construction of structures over 3 st ies In eight. Main Service To 46.00 WEE200A CCU000A .5,so NEW CONST. DWELLING OCCUP. 3.5QF°; OR ACC. sr. ( uBLDS. EW cor M NON-RESID. 97.50 8 PSINGLE OVTLhT CIR.OWER APPARATUS ourtFroRFocruREs Ex. Occup.BAL 20'•00 @ .50 Ex. Occup. °„T,FIXF,S Ao .°E" 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE 43.00 TOTAL FEE $ HAZ. D. FEES IMP FLOOD CDf PARCEL PD HD SUE This permit is hereby issued under the applicable of the Butte County Code and/or Resolutions indicated above for which fees have been By Q j Date PERMIT E PIRES ON I — provisions to do work paid. to ReceiptNo.2 �i! /. 57 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT