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HomeMy WebLinkAbout069-350-011' 69-35411 -DOLS�T�--R—:A, W-: C f767P * 389-67B -67B y%�494-67E-, - .241'Lodgeview Dr,'ORoville 1/4 Lodgeview Dr., OrovilleW.C: DOLSTRA 10 B(reroof/SF), Permit#3059-88_ p 069;`350O11s��:940323E1',s CONTR. Richard Wood, 913 Lon g�BarjRd-.,Or��+e DOLSTRA..WILLIAMs �xa,� VJ+•.v. �x i(new single family) C'ONTR: Sw ems Air Conditioning, 0r0villEt 241'LODCEVIEWpROROVILLE'��R ELESEFRKCH/SFf- o - D �1 , �s �i 1 it i! M it �I 1 ' •f1 a i 1 u 1 1, M1 ' 69-35411 -DOLS�T�--R—:A, W-: C f767P * 389-67B -67B y%�494-67E-, - .241'Lodgeview Dr,'ORoville 1/4 Lodgeview Dr., OrovilleW.C: DOLSTRA 10 B(reroof/SF), Permit#3059-88_ p 069;`350O11s��:940323E1',s CONTR. Richard Wood, 913 Lon g�BarjRd-.,Or��+e DOLSTRA..WILLIAMs �xa,� VJ+•.v. �x i(new single family) C'ONTR: Sw ems Air Conditioning, 0r0villEt 241'LODCEVIEWpROROVILLE'��R ELESEFRKCH/SFf- o - D f 1 a �1 , �s �i 1 it i! f 1 a �1 �s �i it i! it �I ` _. + k i.. .. .� .,r , i rr"• .�a'—t" Ys.. f j.. ,i 1 a"'.i ..�'l:t �.}/'. ;,,,069 350-011141?'�s1 9a,` sr f t 94-032: , .. t.i w=D_OLSTRA{ CON: , ,DOLWTIRLALELECT x ,;;�A;•,.�`;��';�s.���.�'�';M` ��s�rt>r �` 24'1-LODGEVIEW DRf IOROVILLE J "ELY SER„CH/SF''�', &r�llft lift t r OFFICE COPY •Address z �xny 7, rELECTRIC�* a�� h;�t ��^�"`���.• ' • � ,Meter�By�.Y 1 �' Dagt,eyy�a(�� � i • pt 1 J_ - COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-754 PERMIT NO. APPLICATION AND RERMIT ASSESSOR PARCEL NUMBER - 069--3508011 ZONING AR 1 BUILDING PERMIT OWNER WILLIAM DOLSTRA TELEPHONE 589-0868 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 241 LODGEVIEW CONTRACTOR'S NAME DOLSTRA ELEC TELEPHONE , CONTRACTOR'S MAILING ADDRESS LODI , CA Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 20.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER„ LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 241 LODGEVZEi,I DR PERMIT FEE $ OROVILLE PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 s Solar or heat pump water heater 23.00 Water piping 15,00 LOT NO. SUBDIVISION'S NAME PARCEI. MAP 1 Each gas water heater or vent 15.00 USE OF STRUCTURE SF ITL Duplex ❑ Mobilehome ❑ Other SPECIFY Gas piping system 1 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 TYPE OF WORK New O Addition ❑ Remodel O Utilities''O • Installation C3 Other O I r►_pa • TO & Alm Descfil9e MP I } PERMIT FEE $ Contractor ELECTRICAL PERMIT Filing Fee 20.00 Main Service ( 600V 01 LE2OOA OR LESS ) 23.00 3. W Main Service ( 200A TO 1000A ) 46.00 ' NEW CONST. DWELLING OCC P. OR ADDNS. ( a ACC. BLDS. ) SD. 3.50 FT. CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one) ❑ 1 am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification 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 I NEW CONST. MULTI -OUTLET -NON RES ( BRANCH CIRCUITS ) @7.50 ( POWER APPARATUS ) & SINGLE OUTLET CIR. Ex. Occup. ( OUTLET OR FIXTURES ) SAL. @ 1.00 Ex. Occup.FIXED SIRENS. (OUTLETS IRESIO.) E EA. ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 3.00 WORKER'S COMPENSATION INSURANCE 1 declare under penalty of perjury (check one): O 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. fid' I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. k 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 $ SH 66.00 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, judgments, costs, and expenses which may in any way accrue against said Count I o sequ nce of he gryfiting of this permit. I X^ ��� ��{—•— , C Date / y Signature of Applicant - O Owner O 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 TOTAL FEE $ 66.00 HAZ. I D. FEES IMP I FLOOD I CDF PARCEL I PD I HD I ISSu 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 J��4�` Date /ate Cl PERMIT EXPIRES ON Motel Receipt No. 156204 WHITE-O.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION ! 7 County Center Drive - Oroville, California 95965 - Telephone (916) 5 4y, PERMIT NO. 3 - APPLICATION AND PERMIT `7q'^ ASSESSOR PARCEL NUMBER 069-350-011 AR1 ZONING BUIL ING ERMIT OWNER WILLIAM DOLSTRA TELEPHONE 589-0868 SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 241 LODGEVIEW CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS MEOW Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is LENDER'S MAILING ADDRESS Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 241 LODGEVIEW DR PERMIT FEE $ 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 CX Duplex ❑ Mobilehome ❑ Other SPEC IF\' Gas piping system 1 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W @20.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation 1:1Other ❑ DescTJIFIp.E TO 200 AMP PERMIT FEE $ Contractor ELECTRICAL PERMIT Filing Fee 20.00 Main Service ( 10V OR LESS ) 200A OR LESS 23.00?3.00 Main Service ( 200A TO 1000A ) 46.00 NEW CONST. DWELLING OCCUP. OR ADONS. ( & ACC. BLDS. ) SO, 3.50 FT, CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one) ❑ 1 am a licensed under provisions of Chapter 9, Division 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 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 ) & SINGLE OUTLET CIR. Ex. Occup. ( OUTLET OR FIXTURES ) AL. @ 1.50 Ex. Occup.FIXED APPLNS. OR ( OUTLETS (RESID.1 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): ❑ This permit is for $100.00 (valuation) or less. ❑ I 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. d& 1 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 $ Ym 66 -nn 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, judgments, costs, and expenses which may in any way accrue against said Cou;MonseqEce of a gr 4i of this permit. X-- Date2. !� Signature of Applicant - ❑ Owner ❑ 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 TOTAL FEE $ HAZ. I D. FEES IMP I FLOOD I CDF PARCEL I PO 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. /� l/ By / Date "/ 9 7 PERMIT EXPIRES ON �/f 95 (te) Receipt No. 156204 WHITE-D.D.S.-S.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT .41 e COUNTY OF BUTTE - DEPARTMENT -OF ©EW-LOPMENTSERVICES -UIDING DIVISION 7COUNTY CENTER DRIVE -OROVILLE,�CALIFORNIA 95965-TELEPHONE(9t� )5 8-7541 PERMIT APPLICATION, DATA SHEET OWNER %20e 57`� I Proposed Building Use C� - Building In`.spector Date At time ofpermi application, I was advised the following data must be'submitted prior to permit processing and/or issuance: DATE RECENED BY 1. All items have been submitted.................:'l..................... . 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 P.eanspedion requ�- required. .. to B�;ldir g �nspedor (Date) 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. ......... I ............................... . 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. i When you issue the permit, process as follows: L, -M it to owner. 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: 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 Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder - Copy - Department of Public Works `. COUNTY OF BUTTE - BUILDING DIVISION ;fr DEPARTMENT OF DEVELOPMENT SERVICES+ 1469 Humboldt Road, Chico, CA - (916) 891-2751 7 County Center Drive, Oroville, CA - (916) 538454.1' 747 Elliott Road, Paradise, CA - (916) 872-6307 CORRECTION NOTICE ��5 fry ��/ - 63 3 NER PERMIT NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact this officeimmediately. r Date- Z inspector REV 10/' 2 PErmit#3059-88 W.C. Dolstra 241 Lodgeview Dr,ORo COUNTY'OF BUTTE - DEPARTMENT OF PUBLIC WORKS •7 County Center.Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT ASSESSOR. PARCEL NUMBER ZONI�NGGG BUILDING PERMIT OWNER Cc �,.1 1 . �/�.I :l + Ir '.V' n . TEf+/ "EPHO /E 6I) / Imo/ SQ. FT,:_ OCC. BUILDING VAL UATION .. //J� r, j OWNERS MAI - ING ADDRESS" V; 11� CO'NTRACTOR'S'NAME /')/A) hl,- TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ _�/A..�i ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS //f� /� t Permit fee $ PLUMBING PERMIT Filing Fee 10.00 U Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 00 Each qas water heater or vent 5n5.00 USE OF STRUCTURE SF,4 Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets Building sewer Mobile Home I S I G I W 0.00ea TYPE OF WORK New❑ Addition [J Remodel[:] Utilities fIn�allation❑ Other Describe work: F 07,')/ C +t / + Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service e00v OR LESS 10.00 1100 AMP OR LESS 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- t 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.y OR ADDNS. ACC. BLDGS. ,/2¢Sgft NEW CONSTR.U TI -OUTLET 2.50 ea, NON-RESID BRANCH CIRCUITS) POWER APPARATUS &) SINGLE OUTLET CIR. 200000 EX. Occup(OUTLETS OR FIXTURES .0@030 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA.7 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 g Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one):MECHANICAL ❑ The permit is for $100.00 (valuation) or less. ,Y ❑ 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. ,t N 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. 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 County of Butte to enter upon the above-mentioned property for inspection purposes. also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, osts, and xpenses which may in any way accrue against sa dff7nty/in con .quejj' of the granting of this permit.1. fs -This X / l --� t e I Date Cry Signature of Applicant — Owner g PP � Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ occu P. CONST,TYPEJ JSC..OLJFU)O3fFZW7 NO SSUE permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees ,have been aid. i ��/� p T IRECOTO�II OF PUBLIC ORK�/� 1kKion (�Receipt By11 .� 7 PERMIT EXPIRES Date 7 No. /��n"7` / WHITE-D.P.W., TELLOW-A5SE3SON, PINK -INSPECTOR, GOLDENROD -APPLICANT -, - T COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Orovilie, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT )i ASSESSOf} PARCEL NUMBER 6[Jj (J[EL ZONIN7V I BUILDING PERMIT owN PHO E SO. FT. OCC. BUILDING V UATION 16672 W 'S MAI ING DRE S f V ,LIS CON ACT R RA F PHONE CO TRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER VNKNOWN Total Valuation $ Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee • $ ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee - $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $1 BUILDING ADDRESS kado & 4 Permit -fee $ 3 PLUMBING PERMIT Filing Fee 10.00 Trap 1 2.00 itEach 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 A SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home Is 10.00 ea TYPE OF WORK New ❑ Addition ❑ R ode ❑tilities9 allation Other Describe work: ✓ 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 (checkone): p Y p Ir Y )� ❑ 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) ❑ I, as the owner, am exclusively contracting with licensed contract- ontract- ors. ors.(Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.BI , OR ACDNS. ACC, BLDGS. /zQsgft NEW CONSTR.MULTI-OUTLET NON.RESID BRANCH CIRCUITS) 2.50ea (POWER APPARATUS e (SINGLE OUTLET CIR. Ex. OCCUp�OUTLETS OR FIXTURES 200800 eALO 30 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA.) 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. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. No: ce 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 to building construction, and hereby authorize representatives of the County of 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, osts, nd pxpenses which may in any way accrue again t s d o nt in co quen o the granting of this permit. X_ Signature of Applicant — Owner N3 Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct -RE ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE OCCUP, CONST.TTPC SCHOOL FLOOD PARCEL PD -NOJ ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indi above for which C PUB BY P T EXPIRES Date the applicable provi- resolutions to do f s ave been paid. RKS Date Receipt No. WHITE-D.P.W., YELLOW-ASe(S R, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE -'Department of Public Works 7 County Center Drive, Oroville,.CA 95965 Phone: 916-538-7541 OWNER -BUILDER VERIFICATION Attention Property Owner: 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 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:�M Name bull Address City Phone Contractors License No. 4. I plan to provide portions of this work, but I have hired the following person to coordinte, supervise, and provide the major work: Name Tori,( 0 Address City. Phone Contractors License No. 5. I will provide some of the work but'l have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work Signed:' Property Owner G Social Security Number +� Date 9 ` / 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. COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA i 95965 Phone: 916-538-7541 OWNER -BUILDER VERIFICATION Attention Property Owner: 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. mol. I personally plan to provide the major labor and materials for construction of the proposed property improvement es or no) \42. I k v /have not) signed'an application for a building permit for the proposed work. _ r 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 Address ` Phone Type of Work i Signed: / Property Owner 1 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.