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HomeMy WebLinkAbout071-470-019_ - '***-.D•.nald R. White ` G —C)V� r @�e of-pri.dirt rd. ,app.2 mi.SE�of Lumpkin �d,app.2 mi.SW of Feather a Falls Permit #4726-5•OP,E(util.,MH) ELEC . " - 3 --• 2 OOR 44 � t� GAS O-E-0 ' D SUPPORT STRUCTURE REQ. COMPACTION TEST REQ 19a eLqtp-i=os=9s- ' Contr: Rodr�i-"y N. Martin, F.R. Permit#53=6'8-80MHI..�} I s s pd';�O" • PERMIT,NO. 4726-80P,E PERMIT'EXPIRES OWNER Donald R. White CONTR. owner �J g ASSESSOR PARCEL 71-05-95 LOCATION @ end of pri.dirt rd.,app.2 mi.St` of Lumpkin.Rd.,app.2 mL SW of Feather Falls i, Y' Temp. Power Pole Called PG&E [ G Temp. Elec. Service o` o Called PG&E LC/ r s Temp. Gas Serv/.c,. Calle PG&E J B INALED (Date) J� d Signature k J = OK O = Not OK = Not Applicable * = Not Ready RESIDENTIAL (Single and Duplex) , ' Date UNDERFLOOR Plans OK except #'s Date FRAMING (Continued) 1. Zoning requirements -Setbacks -Easements 48. Property Line Firewall & Openings 2. Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth 49. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits 3. Ftg., Garage; Soils -Steel- / /" Ftg. Depth 50. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 4. Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth 51. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab 52. Siding -Nailing -Veneer 6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab 53. Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access 7. Piers -Fireplace Ftg.-Steel 54. Glazing Area -Glass Protection -Skylights -Plastic 8. D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test 55. Shear Walls; Nailing -Bolts 9. Gas Pipe; Size -Anchors 10. Water Pipe; Test -Anchors -Regulator -Service Test 11. Electric; Underground 12. Plenums & Ducts; Clearance -Material -Support -Ins. Card -BI 13. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date Card -BI Date FINAL (Plans) OK except q's 56. Ext. Steps -Door & Sidelight Protection -Landings Card -BI Datil Date Card -BI Date PLUMBING (Permit) OK except q's 14. Water Ht.; Vent -Access -Combustion Air 57. Smoke Detector 58. Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 15. Water Pipe; Test & Anchors -Nail Protection 16. D.W.V.; Test-Fttngs & Anchors -Nail Protection 59. Bedroom Exiting 17. Shower Pan; Test, First Floor -Tub Access 60. G.F.I. & Bath Fixtures & Tub Access 18. Test Tub & Shower, 2nd Floor -Tub Access 61, Elec. Trim & Subpanel; Breaker Sizes -Labels 19. Gas Pipe; Size & Anchors 62. Stairs & Rails 63. Fireplace or Stove; Clearances -Hearth 64. Elec. Outlets at Wood Panel; Int. & Ext. Card -BI Date Card -BI Date 65. Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance Card -BI Date Card -BI Date 66. Elec. Outlets & Receptacles at Kit. Counter Date ELECTRICAL Permit OK except N's 67. Garage Fire Door; Swing -Landing -Closer 68. A.C. Duct in Garage -Damper 20. Fixture & Transformer Clearance -Ins. Protection 69. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.- In Garage; Above Floor-Mech. Protection 21. Elec. Receptacles Spacing -Lights &Switches at Doors 70. Plb., Elec. & Mech. Equip. Listed for Location 22. 23. Size Boxes & No, of Conductors -Stapled Romex Installed Close to Edge of Studs & C.J. 71. 72. 73. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec. Insulation -Foam -Looked in Attic E] Yes Guard Rails & Deck Construction -Post Caps 24. Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water 25. 2 Appliance Circuits in Kitchen &Conductor Size 74. Fdn. Vents& Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under, Floor ❑ Yes 26. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or At 27. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al, Insulated Neutral ❑Yes El No 75. Following.instld.: Drive ❑ Yes []No: Walks ❑ Yes ❑ No; Planters ❑Yes ❑No 28. 29. Service -Riser Conductors & Ground -Main Disconnect Equip. Clearances; Panels-Motors-Mech. Equip. 76. Stucco; Brown -Finish 77. A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet _ 30. Clothes Closet Light -Shower Light 78. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs. 79. Water Well; Disconnect, Electrical, Plumbing Card B -I -- --... -- Date Card -BI Date 80. 81. 82. 83. Exterior Elec. Trim; G.F.I. Receptacle -Underground Ventilation throughout House Glass Protection _ Corrections from Previous Inspections _ Card B -I Date Card -BI Date Date _ MECHANICAL (Penr,it) OK except N's 31, A.C. Ducts: Insulation & Support 32. Vent Fan; Exhaust above Insulation 33. Condensate Drain & Overflow; Size & Grade 84. Gas Test -Meters Tagged; Gas -Electric 85. W. Water & Sewer Connected -C/O to Grade -HD Approval Energy Compliance Certificate -Other Certificates Card -BI Card -BI 34. 35. Furnace -Vent: Access -Comb. Air -Return Air Vent -115V outlet Attic Access & Platform if Furnace in Attic Date Card -BI Date Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date FRAMING(Plans) OK except q's Comments at Final: 36. 37. 38. 38. 39. 40. Sills; Proper Material & Anchors _ Walls: Studs -Nailing, Spacing & Bracing -Plates -Sound Bearing Walls over Girders & Floor Nailing_ _ Draft_ Stop in Walls (rat proof) _ Fire Stops; Furred Ceilings -Stairs -Chases -Tub 41. 42. 43. 44. 45. Header & Beam -Size & Bearing Hangers -Post Caps -Anchors -Connectors Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng. Fireplace Ties or Type A Flue -Fireplace Throat Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles _ 46. 47. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions Garage Fire Protection Framing (NOTE:Anentrymust be made each time youvisit jobsite) COUNTY OF BUTTE ,f1EPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE OROVILLE, CALIF. - 534-4541 j CERTIFICATE OF OCCUPANCY This mobilehome has been installed in accordance with the requirements of the California Administrative Code, Title 25, Chapter 5, under permit number ' for the following location: Owner Owner's Address Mobilehome Mfg. Model Year Insignia No. Serial No. It is hereby certified for occupancy at the above described location and may be occupied. Director of Public Works Date By THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED White - Owner, Yellow - Installer, Pink - D.P.W. COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Orovi Ile — Phone: 534-4541 Skyway and Elliott Road, Paradise — Phone: 872-2961, Ext. 57 CORRECTION NOTICE BUILDING OR PROPERTY ADDRESS A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. Date Inspector �� S V = OK 0 = Not OK — = Not Applicable MOBILEHOMES MISCELLANEO!1S * _ Not Ready , Date MOBILEHOME UTILITIES (Plans) OK except N's o Requirements—Setbacks—Easements Date DECKS, COVERS, CARPORTS, ETC. (Plans) OK except N's 1. Zoning Requirements—Setbacks—Easements 42, ­Soils 2. Footings; Size—Depth—Spacing—Connectors AoOgewer; Location—Test—Fall-C/O—Concrete 3. Decks; Girders and/or Joists—Decking—Bracing—Stairs—Rails ater; Location—Test 4. Wood Awn.; Posts—Beams—Rftrs.—Connec.—Shthg.—Rfg.—Bracing 45e-Ee tricity; Location—Clearances—Grnd. !. I!V/ Amp-6enerete-+ _ 5. Alum. Awn.; Columns—Connections—Splice—Decal—Enclosures "V" Gas ovation—Test—Wrap:/ /"L"ft./ /"Nat. or/ /"L"ft./ /"LPG 6. Carports; Windows—Doors Utility Clearance 7. Elec. Card -B Dataw -- &' Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date Card -BI Date MOBILEMME INSTALLATION (Plans) OK except !1's Card -BI Date Date Card -BI Date POOLS (Plans) OK except Ws Zoni g Requirements—Setbacks—Easements 1, Setbacks—Easements ootings; Size—Spacing—Marriage Line 2. Soils; Compaction—Structure Stability -_%—Ga �MH Test—Demand—Valve—Connector 3. Pool Structure; Steel—Connections—Thickness—Dead Men—Lining Electricity; MH Test—Crossovers—Breakers-Clearances 4. Elec.; Receptacles and Lighting; Distances—GFI . Drat ; MH Test—Fall—Flex Connector 5. Elec.; Pool Lighting; 15 volts—GFI &a�H Test—Regulator—Connector 6. Elec.; Enclosures; Conduit Entries—Terminals—Listed at and Sewer Connected—C/O to Grade—HD Approval 7. Elec.; Bonding; Metal w/5'—Circulating Equipment—Heater A-16as and Electricity Tagged 8. Elec.; Grounding; Equip. w/5'—Circulating Equip.—Pool Lghtg. Boxes—Enclosures—Panel boards—Ins. to Main in Conduit xit ; Insp.—Sketch Cert. of Occupancy g. Health Department Approval 10. Plumb; Cir. Test—Water Supply Test Card B -I Date , rd -BI Date Card -BI Date Card -BI Date Card B -I Date Card -BI Date Card -BI Date Card -BI Date MOBILEHOME INSTALLATION INSPECTION CHECK LIST 1. I's the mobilehome located with r wired separation from lot lines and buildings and generally conform to plot plan? Yes 2. Does the mobilehome have required clearances above ground? (Sec.5085) Yes -1-90 — 3. Are footings and supports .properly sized, spaced, and braced as pe approved plans? (Note possible variation at spring shackles.) (Sec. 5082 & 5083) Yes_ No 4. Is the mobilehome level? (Sec. .5088) Ye.s.No_ 5: If moree�an a single -unit, are crossover connections properly installed? (Sec. 5088) Yes 6. Water A. Isflexi connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes B. Test - Does water.piping withstand working pressure or 50 lbs. air test? Yes_ C Backflow - If coach is not State of California approved, does station have backflow device and pressure -relief valve? Yes_ No 7: Wastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? YesyNo B. Does it have minimum k" per foot slope and is it properly supported? Yes_z_�oL C. Are any leaks detected in drainage system after running 3- llons 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 8. Gas Piping and Gas Vents A. Connector - Is mobilehome connected to the gas supply with an approved 3/4" minimum mobilehome connector not' more than 6 ft. long? Note: All piping is to be at least as large as the mobilehome gas line iiilet without reductions other than the mobilehome connector. Yes No B. Test OK s p dZe w' g procedure? Yes_ No 1. en all connector valves. 2: Shut off appliance burner and pilot valves. 3. Air test with manometer to 10"-14" water column, or test with slope gauge (minimum 6oz.-maximum 8 oz.) calibrated in tenth pound increments. Test for 10 min. without drop. 4. Connect gas meter to mobilehome with connector, turn on gas, test connections with soapy water. C. Are all appliance vents properly installed? Yes_ No,_ MOBILEHOME DATA Manufacturer and/or Namestyle 77 � Length? Width Vehicle Serial No. Z-1 State Identification No. 7 O Additional Information or Comments: 9. Electrical A. Is service large enough to provide adequate amperage -to mobilehome (must equal rating of mobilehome with a minimum of 16 amp) 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 �'�4L D. Is continuity test satisfactory as per the following procedure? Yes !/No k 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 mobilehome 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 water and sanitation? 11. If everything okay, sign off card and tag services. MOBILEHOME DATA Manufacturer and/or Namestyle 77 � Length? Width Vehicle Serial No. Z-1 State Identification No. 7 O Additional Information or Comments: I 6 COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS6� PERMI NO. O 7 County Center Drive - Oroville, California 95965 - Telephone 916/5 41 APPLICATION AND PERMIT, ASSESSOR PARCEL NUMBER Z�p.rv,14 y /0 , / YCIUtI4 BUILDING PE WT /docs OWNER / ` Oti TELEPHONE r 7� SO. FT. OCC. BUILDING VALUATION OWN.ER�'S MAILING AD ESSc../ Q� � C/ �L CONT CTOR'S NAME 1 !1 Nem , TELEPHONE 61fZ ovy CDNTRDACTD ROS'kAILINoG ADORE CONSTRUCTION LENDER UNKNOWN Fireplace Total Valuation Is LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEERLICENSE 1114-2.11 NO. Plan Checking Fee M $ -04) Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ ILDING ADDRESS D OF PW. D/,ET 2D. APP Ya M/. 5C OF PLUMBING PERMIT Filing Fee 3.00 LOMPi�/i1� 90. Al /iP%� Z GU Each Trap 2.00 Repair drainage or vent piping 2.00 Water piping LOT NO. SUBDIVISION NAME 7PARCEL MAP Each qas water heater or vent 2.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome� Other SPECIFY Building sewer Lawn sprinkler system 2.00 TYPE OF WORK New ❑ Addition ❑ Remodeell ❑ Utilities ❑ InstallationI _0ther ❑ Describe work: loV,7)( / F'li' /Z l/TIL 4L-1eV _ L�7Z�o i�0 Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 3.00 Main service s00v DR LESSL 100 AMP OR ESS 5.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING OCCUP,& OR ADDNS. ACC, BLDGS. 22 sq ft 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*Codeand my license is in full force and effect. License No., 47 7� Classification ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NON-RESID R BRANCH CIRCTITS 2.50 ea NEw CONSTF; POWER APPARATUS &) NON-RESID. '(SINGLE OUTLET CIR. EXDCCUp(OUT LETS OR FIXTURES 50@25¢ . BAL212C FIXEDAPPLNS, OR Ex. Occup.(OUTLE TS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 6.25 Permit Fee $ Contractor 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. MECHANICAL PERMIT FiIingFee 3.00 Heating Cooling Hood 2.00 Ventilation Permit Fee $ Contractor I certify that i have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against . all liabilities, judgments, costs, and expenses which may in any way accrue ty in consequence of the granting of this permit. aga�=L;-n_16'-7Z,�DThis XDate J Sign tore of A plicant — Owner El 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 $ ,00 Land Development Fee $ TOTAL PERMIT FEE $ 570.00 OCCUP. DROOP I TYPE OF CONST, PARCEL PCI HD IssuE j/ permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR F PUBLIC BY PER EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date /0 Receipt No. WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT BUTTE COUNTY 'DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA. PHONE: 534-4541• MOBILEHOME INSTALLATION SHEET 1. Owner's name: 2. Instal:ler's name: oC' �e / /� / 3._ Is the site currently under permit? Yes No . (If yes, furnish permit number Z /� ) OR s. Is the site an existing site? Yes / / No /% ~ •(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 /,'<I No (If no, clarify ) 5. What is the mobilehome electrical rating?----------------------- O © Amps .6. -What is the mobilehome site service rating?--------------------- ©O Amps 7.. What is the mobilehome site circuit breaker rating?------------- ?_c�0 'Ampe 8. Is there any other electric load to be served'by the mobilehome siteservice? -------------------------------------------- ------- Yes No (If yes, identify the load and size: (Load) (Amps) 9. What is the mobilehome site gas pipe size? ---------------------- %� (in.) 10. What is the type of gas service? ----------------------------- Natural �:. LPG 11., What is the gas pipe length from meter or tank to the mobilehome? (ft.) 12. .What is the mobilehome gas demand?------------------------------ %' (BTU) (This information not required if pipe length•less than 6 ft. on natural gas . or less than-50--ft. on LPG.) i MOBILEHOME SUPPORT DATA . If other than single wide, Mobilehome Mfr. f � g� furnish Setup Model No. <z�5'1/ Year WidthZ�e (ft.) Box Lengthjr73 (ft.) Tagalong or Expando Size ft. x ft. (SHOW SUPPORT DETAILS BELOW) w On all mobilehomes manufactured after October 7, 1973; furnish manufacturer's installation manual and structural setup sheets (if not on file with the County of Butte). All center supports measured from front of mobilehome unless otherwise specified. Footings (check one) Single 11, Wood either. _ A D C2 (ft.)(in.) Center support locations* (ft.)L (in.) pressure treated or /Z x 30 (in.) (in.) (in.)I (in.) Max. Pier Spacing • (ft.)(in.) *If center piers are other than drawn above, _draw... in locations,_ spacing, and dimensions.. foundation grade. / Lx 301 (in.) (in.) ❑ 2. Other ( specify) Center support footing sizes Supvorts (check one) Concrete block: l Zx 3d 2i Other ( specify) in. kw—tagalong or Expando,' show support details. (in.) (in.) /Z x34 -- Typical Support (in.) (in.) Footing Size /Z x 30 (in.) (in.) (in.)I (in.) Max. Pier Spacing • (ft.)(in.) *If center piers are other than drawn above, _draw... in locations,_ spacing, and dimensions.. COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PE MIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone 916/534- 41 APPLICATION AND PERMIT ASS 9R PAFj,�EL UM " /—(��j—� ZONING /ua BUILDING PE I oE6` 1A� ,'IrTC— TC EL�Hof, SO. FT. OCC. BUILDING VALUATION OWNER'S O W NEORXMAI��4ly, ESSFCfi77-&Fr —�5 C4 ? 1? O "�"'I' CONTRACTOR'S NAME. VItlee- TELEPPHHONE CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER UNKNOWN Fireplace Total Valuation $ LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR E GIN ER LICENSE NO. Plan Checking Fee I $ e 0o ' Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ I DING ADDRESS D OF Pod /2T. P -D / c�N/ , . P. Z til �. PLUMBING PERMIT Filing Fee '(,i.00 Each Trap 2.00 Repair drainage or vent piping 2.00 Water piping A0.00 LOT NO.SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 2.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome Other SPECIFY Building sewer 1 70-0 Lawn sprinkler system 2.00 TYPE OF WORK New Addition F1 Remodel❑ Utilities Installation❑ Other❑ Describe work: — Permit Fee $ 30,00 Contractor Q �� ELECTRICAL PERMIT Filing Fee /0.00 Main service 1000V OR 0 AMP ORSLESS 5.00 00 00 Main service EA. ADD'L 100 AMP 2.50 as� NEW CONST. DWELLING OCCUP.& OR ADONS. ACC. BLDGS. 20 sq it 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 m license is in full force and effect. y License No. Classification I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract-, ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONSTR. MULTI -OUTLET 2,50 ea NON•RESID BRANCH CIRCUITS) NEW CONSTR. POWER APPARATUS a N O N•RESID. (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 50ALK I@'x1 B OQ FIXED APP LHS. OR Ex. Occup. OUTLETS (RESID,) EAJ 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 6.25 00 Permit Fee $ Contractor 009111uz 7rt/"P MECHANICAL PERMIT Filing Fee 3.00 WORKMEN'S COMPENSATION INSURANCE 1 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. Heating Cooling Hood 2.00 Ventilation Permit Fee $ Contractor 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 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 agaiA)saidCounty in consequence of the granting of this permit. cc'' �•-� X Date'/ / 4' � d V Signature of Applicant — Owner X Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0•' deep and demolition or construct- ion of structures over 3 storie in height. Mobile Home Installation Fee $ Land Development Fee $ ^ TOTAL PERMIT FEE $ occuP. GROUP I TYPE OF CONST. PARCEL, 7 PD N 5sue This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTO OF PUBLIC 4.yl!:�,,Date EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS b Receipt No. Z/ 3 WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT 9 oo v 300' -710 1� ._L7�,4cw�1CLO.� rte% written per�nivssion frcm the Department%ot rueno' Works, Co�arity. of Buffe. _ . 36'(U iGty=codons=s aPI7=�Nt -�ft th- of the mobileho e, eltheri — - -� A s-� Q -( directly behind orwi h-in-th�s-re half theroadside ( eft) of thIa. r cePT'� of mobilehome. - I • eakoo e.— - W, tet l-- --be`,� setback of�t. rom e - )i o% operty Lines an a setback r7.7A f, 50ft. from the roa.nterline shalla clear of ructures or eq ipment exc � ptora 2 ft. eave erhang. 1 C_ e --- NOTE--All-�}ater tai—&—azkrn.ansFiiphl(_�e iry' Good " mfices and Accords ce with Recognized lity-prescribed -for the So6c fie use in the . of-a-qa Uniform uilding;' Plumbing &' Machan ca! Codes and the-Rla�i 'M tical Code. 'BUTTE COU TY M . N— This se ; -plans-and-sspe exens-M.UST Kept 6 -vi th .; ia� at all times and it is unlawful to _.-._... _kft_/il @1\f -- P 'T 1' '�/Ssonsame-without01 written per�nivssion frcm the Department%ot rueno' Works, Co�arity. of Buffe. _ .