HomeMy WebLinkAbout072-050-018v
1
ELAM, Bill V
5440 Old Olive Hwy, Oro 1 1�
Contr..Walter Luczak
(reroof/,sf) ^1
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-072-0507018 -• #98=167qL4E ELAM, .BILL_�
.;.5440 OLD OLIVE HWY; ORO
WATKINS PLUMBING -'$� 1' G�� .
REPLACE GAL.WATER w�CO P R
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072-0507018 #98-1677
r ...l, ELAM, BILL.
5440 OLD OLIVE HWY ,OROVILLE
WATKINS PLUMBING
REPLACE GAL WATER W\COPPER
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COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541r PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER 072-050-018
ZONING
BUILDING PERMIT
OWNER BILL SLAM
1E L57922251
SO. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS 5,440 OLD OLIVE HWY, OROVILLE, CA 95966
CONTRACTOR'S NAME WATKINS PLUMBING
TE5LEPHONE34-7773
CONTRACTORS MAILING ADDF'�E- 89 VIA PACANA, OROVILLF, CA 95966
CONSTRUCTION LENDER
Fireplace
LENDER'S MAIUNG ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $
20.00
Permit Fee $
ARCHITECT OR ENGINEERS "UNG ADDRESS
Plan Checking Fee $
BUILDING ADDRESS -
5440 01 D 01 IVE 10a, OROVILI F
Energy Plan Checking Fee $
$
PERMIT FEE $
LOT NO.
SUBDNISIOMS NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
Each Trap
7.00
USEOFSTRUCTURE
SF ,CK Duplex ❑ Mobilehome ❑ Other
SPECIFY
Solar or heat pump water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK' I _
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Ins%llation ❑' Other »7
Describe Work: REPLACE GAL WATER W/COPPER
Gas pieing system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home I S I G I W
@20.00
PERMIT FEE $
35.00
ELECTRICAL PERMIT
Fling Fee 20.00
Main Service zoOA 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. y
License Class (�- .� (P Lic. NO. �%,� 7 9 % („-
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.
❑ 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.
❑ 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 permitis issued.
My workers' compensation insurance carrier and policy number are:
Carrier
Policy Number
(The above sections need not be completed 4 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
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
X f �. . • f 1,� Date -% `.2 it 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.
Main Service 200A TO t000A J
46.00
NEW CONST. DWELLING OCCUP. so
OR ADONS. ( a ACC. BLOS. 3.5QFT;
NpµpOESlpT' MULT"CIRCUI TS
97,50
POWER APPARATUS
a SINGLE OUTLET CIR.
20 R
Ex. Occup. OUTLET OR FIXTURES Bn� @' 0
Ex. Occup. oFIx�LEED�A AESIooERa 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE $
MECHANICAL PERMIT Fling Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMIT FEE $
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST. TYPE
TOTAL FEE $ 35.00
HAZ.
p. FEES IMP
I FLOOD
I COF
PARCEL
I PD
1 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 f es have been paid.
By Date 7/29/98
7/29/99
PERMIT EXPIRES ON '
Date
Receipt No.r+Vv4
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION V
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541/] PERMIT NO.
(Rev. 12/96) APPLICATiON AND PERMIT
"i� �0
ASSESSOR PARCEL NUMBER 072-050-018
ZONING
BUILDING PERMIT
OWNER BILL ELAM
TEfWE2251
SO. FT. OCC. BUILDING VALUATION
OWNERS "AILING ADDRESS 5440 OLD OLIVE HWY, OROVILLE, CA 95966
CONTRACTOR'S NAME WATKINS PLUMBING
TT477773
CONTRACTORS MAILING ADDR!n89 VIA PACANA, OROVILLE, CA 95966
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 Checking Fee $
BUILDING ADDRESS
OLD 01 IVE
$
Energy Plan Checking Fee5440
WZ, OROVILLE
R
PERMIT FEE S
LAT NO.
SUBDNISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
USEOFSTRUCTURE
SF ]ai Duplex ❑ Mobilehome ❑ 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 ❑ Remodel ❑ Utilities ❑ Installation ❑ Other
Describe Work: REPLACE GAL WATER W/COPPER
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
35.00
ELECTRICAL PERMIT
Fling Fee 20.00
Main Service 2t10AORLESS
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. s� -
License Class C -3(o Lic. No. / 22 7 C/ & Z
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ 1, 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.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
Main Service tow To 1000A
46.00
NEW CONST. DWELLING OCCUP.
OR ADDNS. ( 8 ACC. S.
so
3.5¢FT,
NEW CONST. -OUTLET
NON.RESID. U
@7.50
POWER APPARATUS
8 SINGLE OUTLET CIR. J1
Ex. Occup. OUTLET OR FIXTURES
20 @ 1.00
BAL @ .50
FIX
Ex. Occup. ounFrs MI EA.
R
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00 '
Misc. Wirin
23.00
PERMIT FEE S
'
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.
❑ I have and will maintain workers' compensation insurance, as required by Section
3700 If 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.)
jEf 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 %'� �f' �% _
,5 nature 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 Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEE S
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC
CONST. TYPE
TOTAL FEE $ 35.00
HAZ.
D. FEES IMP
FLOOD
CDF
pggCEl
pp
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 f es ' ve been paid.
By �' Date 7/29/98
PERMIT EXPIRES ON 7/29/99
Date
Receipt No. 244682
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
;"� _ ,. - � ,»...: �ti .F - - '"'+-t r kar�'t'Tf�'li`as*�4,�t A,7 �, _','"�-lV+C�'•�`-~`L•--�.,,,�
a` 72-05-18 3205-90B
ELAM, Bill
5440 Old Olive..Hwy, Oroville
Contr: Walter-Luczak
,:. (reroof/sf)
" 14 s :.'r" 7r" � -77777,Y_01 7777 ,Y_
r ,>;- 4 :.v .,a
COUNTY OF BUTTE d DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPUhTION AND PERMIT
ASSESSOR PARCEL NUMBER
72-05-18
ZONING
1
BUILDING PERMIT
OWNER
BILL �� ,
TELEPHONE
S0. FT. OCC. BUILDING VALUATION
35 60 2100
OWNER'S MAILING ADDRESS
5440 Old Olive Hwy, Oroville CA 95966
CONTRACTOR'S NAME i
Walter Luczak
TELEPHONE
589-%91
CONTRACTOR'S MAILING ADDRESS
38 Wahoo Ave. Oroville CA 95966
Fireplace
CONSTRUCTION LENDER
None.
UNKNOWN
Total Valuation Is
FilingFee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ 38.50
ARCHITECT OR ENGINEER
None
LICENSE NO.
Plan Checking Fee
$
Ener Plan Checking Fee
Energy g
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
5440 Old Olvie Hwy,Oroville
Permit fee
$ 48.50
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.SUBDIVISION
NAME
PARCEL MAP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF ® Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
10.00e
TYPE OF WORK
New Addition ❑ Remodel❑ Utilities[] Installation❑ 'Other X
Describe work: Reroof _
I
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 fo ce and effect.
License No.2� 4 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-
ontract-
ors.(Sec. 7044)
ors.
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST, DWELLING OCCUP.&
OR ADDNS. ( ACC. BLDGS.
2/20sgft
NEW CONSTR. ULTI.OUT LET
NON -R ESID BRANCH CIRC ITS
2,50 ea
POWER APPARATUS &)
SINGLE OUTLET CI R. )
Ex. Occup( OUTLETS OR FIXTURES
20 506
9AL0 30
FIXED PR
Ex. Occup. OUTLETS (RESI 0.IEA.)
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.
IX 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 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, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
l
%�'' -- -y' +� *� Date l '�
Signature of Applicant —� OWner ❑ -Contractor Agent ❑
An OSHA permit is required for excavations over 5' 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
E $
48 .50
8 0
HA2
CUA
PARK
$CHL
E
PAR
IssuE
This permit is nereby issued under
Bions of the Butte County Code and/or
work 1n$ cued above for which ffee��have
DIRE - A F PUBI.'ICORKS
I
By(4
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
been paid.
9/13/90
Date
9/13/91
Receipt No.
WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION AN&PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER
72-05-18
ZONING
1
_
BUILDING PERMIT
OWNER
BILL ELAM
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
35 60 2100
OWNER'S MAILING ADDRESS
5440 Old Olive Hwy, Oroville CA 95966
CONTRACTOR'S NAME
Walter Luczak
TELEPHONE
589-0691
CONTRACTOR'S MAILING ADDRESS
38 Wahoo Ave. Oroville CA 95966
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ 38.50
ARCHITECT OR ENGINEER
None
LICENSE NO.
Plan Checking Fee
$
Ener Plan Checking Fee
Energy g
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
5440 Old Olvie Hwy,Oroville
Permit fee
$ 48.50
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 [R Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W10.00e
TYPE OF WORK
New❑ Addition❑ Remodel❑ Utilities❑ Installation❑ Other®
Describe work: Reroof _
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service BOOV 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):
'10tL I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full fo ce and effect.
^'
License No -2a � 42, ClassificationEx.
❑ 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-
ontract-
ors.
ors.(Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. DWELLING oCCUP.1k
OR ACDNS. ACC. BLDGS.
, /z ¢sq ft
NEW CONSTRESIC, RANOOUTLET
NON-RESID BRANCH CIRC ITS
2.50 ea
/POWER APPARATUS 1k
(SINGLE OUTLET CIR.
Occu p(OUTLETS OR FIXTURES
20@500
SAL®30
FIXED APLNS.
Ex. OCCUp. OUTLETS P(RESID .)OR EA.)
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Iyirin 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.
IDI I shall not employ any person in any manner so as to become subject
4� 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
Conlin 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, costs, and expenses which may in any way accrue
against said County in consequ rice of the granting of this permit.
U 1 �
Signature of Applicant — Owner ontractor ® Agent ❑
An OSHA permit is required for excavations over 5' \deep and demolition or construct-
ion of structures over 3 stori s in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST TYPE
TOTAL FEE $ 48.50
HAZ
I CUA I
PARK
SCHL
FLD
I PAR
PD
I Ho
IssuE
This permit is nereby issued under
sions of the Butte County Code and/or
work )c ed above for which fees
DIRE PUB
By
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
have been paid.
ORKS
ate 9/13/90
Receipt No.
No.-23"
WHITE-D.P.W., TEL LOW'ASSC SSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541
APPLICATION AWRERM1T
ASSESSOR PARCEL NUMBER
7Z_05_ a
ZONING
1
BUILDING PERMIT ..-
OWNER `Lalyn
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNER'r MAILING ADD R SSio
CONTRACTOR &t
V
./pULE�E
CONTRACTOR'S MAILING ADDRESS
3"h66 fimt096
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
LENDER'S MAILING ADDRESS
Filing Fee
$ 10.00
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE No.
Plan Checking Fee
19
$
Energy Plart Checking Fee
$ -
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
-
Permit tee
$
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
Sff 92 Duplex❑ Mobilehome❑ Other
• SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home Is G W
0.00 eal
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] Other]'
Describe work: 4fA4t4
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 100VAMP OROR LESS10.00
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification
❑ I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
El I,
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
Main service EA. ADD•L too AMP
2.50
NEW CONST. DWELLING OCCUP.E,
OR ADONS. ( ACC. SLOGS.
�20sgft
NEW CONSTR ULTI-OUTLET
NO 11-RESID BRANCH CIRC ITS
2.50 ea
POWER APPARATUS e
(SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES
20050¢
9AL0300
FIXED
EX. OCCup. OUTLETS PAPLNS.(RESID )REA.)
2.00
Temporary service
10.00
Home Facilities
15.00
Misc. Wirin 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
Conlin g
Hood
3,00
Ventilation
permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
%� Date
Signcture of Applicant — • -Owner 01. Contractor ❑ Agenti❑
1
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 $•
ALSCHL
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CUA
PARK
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ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which fees
DIRECTOR OF PUBLIC
BY
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
have been paid.
WORKS
Date
Receipt No.* 7��?l 07
WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR. GOLD ENROO-APPLICANT