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HomeMy WebLinkAbout072-280-019.~^ - **�William Barbour GAS SUPPORT �TRUCTURE cont Richard Van Stavj4xmVMH,Para. ic | �oaueu uv I L 1=11MINElM N N Jff 1!r i Utility connections shall be within 4 ft. of the mobilehome, either directly behind or within the rear half of the roadside (left) of the mobilehome. 9M4 wMNMn w .urn•+�wrY..w.u'�+^Irn.wlww.w4-wi�?5�1.'. ':w�w4 A permit will be required for the installation of the mobilehome Workmanship Shall ge 1rt� All Materials &nj7ed Good p,cictices and NATE: with Recon the S�erifieo' use in the Accordance rescr�b'A for of a quality Plunking & Machanica! Codes an Uniform Bwlding, Code. the National Electrical MAST �� This set of plans and specifications JUI +0 kept on the job at all times and it i is unl w thout make any changes or a! written permission from the Department of Public ,--Works, County. of Butte. APeh k s j 4 A setback of 5 ft. from thoi property lines and a set -lank of 60f t. from the road centerline shall be clear of structures or equipment exeept fora 2 ft. eave overhang, i r i 1 3UTTE COUNTY DING DEPARtMENI .P_PROVED T.� ..� S7q�/�C3 �a ° /l �- - �:�� Q� a o q_�_'�' '�'� ��., i,� ,' �, .� , __� �. � ,5 -� D � �'Qd J � � - - i y �1 � \ p • ���. n _, � _ ., 4 _ '�--1 � .. • - . ,. � �� - ..� � - - e ' C' � � �- •�• ey � r� o � � � • �, � ti .. �, �� ��e��t E�p��3 � ���� �� ���� � Li�J7 � %d � - °i R ,cy ".?��� �� °� ���� U . r � -J 4��' � ti; y. r . ,. /�� '�y �ia`mt �j� �► C�-�i( fes° � � _ d 7 t. ��^-�( � ✓j� v � t �r � Zr1 ( �� ode v � p i�, e� � �y a � �R � � ., v'� c. �' COUNTY OF BUTTE DEPARTMENT OF PUBLIC 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 5,, under; permit- ! ., /location:/r_ number � - for the following Gi'• z� /-,Y• s ,r -rte Owner Owner's Address j, ��� d`��t- Mobilehome Mfg. vModel"' _ Year � Insignia No. +1 ' J� i� �� � Serial No. It is hereby certified for occupancy at the above described location and may be occupied. f Directorr.of'Public)Works Date By THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED White - Owner, Yellow - Installer, Pink - D.P.W. . !Z!�NWVJ/1�9- %-'Ilk 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. Inspector "� r Date ✓ / 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. t PERMIT NO. PERMIT EXPIRES_ OWNER CONTR. ASSESSOR PARCEL LOCATION • 1938-81P,E William Barbour owner 72-28-19 NIS Rebel Rd.,app.2 mi.S.of Stringtown Rd., Oroville Temp. Power Pole I h Called PG& Temp. Elec. Service Y < o Called PG&E Temp. Ga Service Cal led PG&E JOBINALED (Date) /o ��V/ Signature MOBILEHOME SUPPORT DATA If other than single wide, Mobilehome Mfr. (d lk(041N furnish Setup Model No. Year Width � (ft.) Box Length 572- (ft.) Tagalong or Expando Size ft. x .---- ft. (SHOW SUPPORT DETAILS BELOW) 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. J a= 4 y& Single 2 4 x3' o (ft.)(in.) (in.) (in.) Center support Center support locations* footing sizes (in.) It's, I i+, 3 0 (ft.)(in.) (in.) (in.) r• 3° (ft.)(in.) (in.) (in.) Footings (check one) /1. Wood either pressure treated or foundation grade. 2. Other. ( specify) Supporte•(check one) : Concrete block. E] .2: Other.(specify) ragalong or Expando,' show support details. g. xS- P -- Typical Support (in.) (in.) Footing Size Max. Pier Spacing Z'- D 2Y x 3 0 2 P - -- Max. Overhang (ft.)I (in.) (in.) (in.) (ft.)(in.) a El BUTTE BUTTE COUNTY BUILDING DEPARTMENT *if center piers are other than drawn above, APPROVED v draw in. -locations', spacing,. and dimensions. BUTTE COUNTY. DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA. PHONE: 534-4541 MOBILEHOME INSTALLATION SHEET 1. �Owner's name: 2. Installer's name: Ryo-jj/�R D Vim. SrAUC--R-J.176AVtc4r 3. Is the site currently under permit? Yes _�` No (If yes, furnish permit number ) OR 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 /'""/ No (If no, clarify ) (If yes, identify the load and size: 9. What is the mobilehome site gas pipe size? -------------- (Load) (Amps) (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? 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.) 5. What is the mobilehome electrical rating?----------------------- yy Amps 6. What is the mobilehome site service rating? --------------------- O ® Amps 7.. What is the mobilehome site circuit breaker rating? ------------- l O 6 Amps 8. Is there any other electric load to be served by the mobilehome siteservice? --------------------------------------------------- Yes No'/ (If yes, identify the load and size: 9. What is the mobilehome site gas pipe size? -------------- (Load) (Amps) (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? 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.) J = OK O = Not OK = Not Applicable MOBILEHOMES * = Not Ready MISCELLANEOUS Date MOBILEHOME UTILITIES (Plans) OK except #'s Date DECKS, COVERS, CARPORTS, ETC. (Plans) OK except #'s oning Requirements -Setbacks -Easements 1. Zoning Requirements -Setbacks -Easements oils• Special MH Support -Sketch 2. Footings; Size -Depth -Spacing -Connectors ewe ocation-Test-Fall-C/O-Concrete 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails ater; L ation-Test-Easement Needed (Sketch) 4. Wood Awn.; Posts- Beams-Rftrs.-Connec.-Shthg.-Rfg.-Bracing X-elec—tricity; Location-Clearances-Grnd.-4?-010 Amp -Concrete 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures as; ocation-Test-Wrap: / /"L"ft./ /" Nat. or?2 L"ft./ "LPG 6. Carports; Windows -Doors 4-19-t4 Clearance 7. Elec. S Card -BI Date 04!;f��/_Card-Bl Date Card -BI Date Card -BI Date Card -BI Date Date Card -BI Date MOBILE OME INSTALLATION (Plans) OK except #'s Card -BI Date _ Date Card -BI Date POOLS (Plans) OK except #'s oning Requirements -Setbacks -Easements 1. Setbacks -Easements ,efe--F—ootings; Size -Spacing -Marriage Line 2. Soils; Compaction -Structure Stability Gas; 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 ren; MH Test -Fall -Flex Connector 5. Elec.; Pool Lighting; 15 volts-GFI Water; MH Test -Regulator -Connector 6. Elec.; Enclosures; Conduit Entries -Terminals -listed ter and Sewer Connected -C/O to Grade -HD Approval 7. Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater .'5s and Electricity Tagged 8. Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool Lghtg. Boxes -Enclosures -Panel boards -Ins. to Main in Conduit exits; Insp.-Sketch Cert. of Occupancy 9. Health Department Approval 10. Plumb; Cir. Test -Water Supply Test Card -BI Date Card -BI Date Card B -I Date Card -BI Date Card B-1 Date Card -BI Date Card -BI Date Card -BI Date V = OK 0 = Not OK c = Not Applicable RESIDENTIAL (Single and Duplex) * = Not Ready 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 5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab 51. 52. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers Siding -Nailing -Veneer 6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab 53. Stucco Mesh -Drip Screed-Fdn. Vents-Underfir. Access 7. Piers -Fireplace Ftg.-Steel 54. Glazing Area -Glass Protection -Skylights -Plastic B. 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. 13. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date FINAL (Plans) OK except N's 56. Ext. Steps -Door & Sidelight Protection -Landings Card -BI Date Date Card -BI Date PLUMBING (Permit) OK except q's 14. Water Ht.; Vent -Access -Combustion Air 57. 58. Smoke Detector 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 Card -BI Date Card -BI Date Date Card -BI Date 65. Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance 66. Elec. Outlets & Receptacles at Kit. Counter Date ELECTRICAL Permit OK except p'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. Size Boxes & No. of Conductors -Stapled 71. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec. 23. Romex Installed Close to Edge of Studs & C.J. 24. Equip. Ground made up w/Mech. Fasteners -Bond Gas &Water 72. Insulation -Foam -Looked in Attic ❑Yes 73. Guard Rails & Deck Construction -Post Caps 25. 2 Appliance Circuits in Kitchen &Conductor Size _ 26. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or At 74. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 27. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or A1, Insulated Neutral ❑Yes ❑No 75. Following instld.: Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No; Planters ❑Yes ❑No 28. Service -Riser Conductors & Ground -Main Disconnect 76. Stucco; Brown -Finish 29. Equip. Clearances; Panels-Motors-Mech. Equip. 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 80. Exterior Elec. Trim; G.F.I. Receptacle -Underground Card B-1 Date Card -BI Date 81. Ventilation throughout House Card B -I Date Date Card -BI Date MECHANICAL (Permit) OK except q's 82. Glass Protection 83. _ Corrections from Previous Inspections 84. Gas Test -Meters Tagged; Gas -Electric 31. A.C. Ducts: Insulation & Support 85. Water & Sewer Connected -C/0 to Grade -HD Approval _-_ 32. Vent Fan; Exhaust above Insulation 86. Energy Compliance Certificate -Other Certificates _ 33. Condensate Drain & Overflow; Size & Grade 34. Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet 35. Attic Access & Platform if Furnace in Attic Card -BI Date Card -BI Date --- Card -BI _ Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Comments at Final: Date FRAMING(Plans) OK except N's 36. Sills; Proper Material & Anchors 37. Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound _ 38. Bearing Walls over Girders & Floor Nailing 39. Draft Stop in Walls (rat proof) 40. Fire Stops; Furred Ceilings -Stairs -Chases -Tub 41. 42. 43. 44. Header & Beam -Size & Bearing Hangers -Post Caps -Anchors -Connectors Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shlhng.-Rfng. Fireplace Ties or Type A Flue -Fireplace Throat _ 45. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 46. Bdrm. Windows 7®rxiting Doors -Sill Hgt. & Dimensions 47. Garage Fire Protection Framing (NOTE:Anentrymust be made each time youvisit jobsite) COUNTY OF BUTTE -'DEPARTMENT OF PUBLIC WORKS 7 Ctunty Center Drive - Oroville, California 95965 - Telephone 916/534-4541 ''APPLICATION AND'PERMIT ERMI NO. ASSESSOR PARCEL NUMBE /l' - /Lg / ZONING 4 BUILDING PERMIT O TELEPHONE SQ. FT. OCC. BUILDING VA ION/f/A/ °I' 7�'";�,� 'OiZ 5x&1 Josue CONTRACTOR'S NAME ©all TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDE UNKNOWN Total Valuation is Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR EN GI R W LICENSE NO. Plan Checking Fee C c $ O 0 Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILD NG ADDRESS PLUMBING PERMITg Filin Fee 10.00 ��-�v�'�—�nTp�•�/� s ,��,��L 2� �� /y Each Trap 2.00 - Repair drainage or vent piping 5.00 /y/�,,, Water piping 0.00 LOT NO.SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets /,Or p 67 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome�Other SPECIFY Building sewer 0.00 Lawn sprinkler system 5.00 TYPE OF WORK New El Addition❑ Remodel❑ Utilities Installation[] Other ❑ Describe work: Permit Fee $ Q, p Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 5.00 5--00 Main service EA. ADD'L 100 AMP 2.50 2, 5-0 NEW CONST. (DWELLING OCCUP.5J) OR ADDNS. ACC. BLDGS. 20 sq CONTRACTORS LICENSE LAW I declare under penalty of perjury (Check one): ❑ 1 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 �42 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 -P ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST R '.OUTLET 2,50 ea NON.RESID. BRANCH CIRC TS NEW .CONSTR /SINGLE OUTLET CTR. POWER APPARATUS &) NONR E51D. ( / so @ 25C Ex. OCCUR OUTLETS OR FIXTURES BAL@1 EX. OCCU IXED APPLN5. OR p•�OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 -O Misc. Wiring 7.50 — r O V _ Permit Fee $ S36S U Contractor MECHANICAL PERMIT Filing Fee 10.00 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ 1 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 3.00 Ventilation permit Fee 3 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, cost and expenses which may in any way accrue agai aid Cou t 'n s nce of the granting of this permit. _ Date ��� Signature of Applicant - Owner Contractor ElAgentwork An OSHA permit is required for excavations over 5'0" deep and dem ition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ g' , Oc Cu P. GROUP I TYPE OF CONST. I PARCE PD D 155U This permit is hereby issued under sions of the Butte County Code and/or indicated above for which DIRECT O PUBLIC PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS t[] �� 42 Z U— Receipt No. 50y WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT - f COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PE IT NO. 7 Covnty Center Drive - Oroviile, California 95965 - Telephone 9A/534-454 APPLICATION AND PERMIT ASSESSOR PARCEL NU BER 7S - 7�- l �'f ZIv— ONING A b— bp BUILDING PERMIT OWNER Wit -LI M (j tlRL30uP, TELEPHONE SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS P -C). (30-A a* 1 s s,�N sos�= eoq. ONTRACTO SNAME 1CWAR0 IQN STGiucRn1 M. q. St�Rulc(E TELEPHONE ,2-e36 CONTRACTOR'S MAILING ADDRESS 3Q eAMOLL t_,v 6Rlgpf5 Si to 9 CONSTRUCTION LENDER UNKNOWN Fireplace Total Valuation $ LENDER'S MAILING ADDRESS Permit Fee F10 $ /-0 �0 ARCHITECT OR ENGINE LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILDV4G ADDRESS � S 9,,c7/3&_,e75 • APR,2 MSI. S. o� PLUMBING PERMIT Filing Fee 3.00 S7PIA/ r ��/VD' Each Trap 2.00 Repair drainage or vent piping 2.00 ��I�ILLf� Water piping LOT NO. SUBDIVISION NAMEPARCEL MAP Each qas water heater or vent 2.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF ❑ Duplex ❑ Mobi lehome � Other SPECIFY Building sewer Lawn sprinkler system 2.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Ut' ities ❑ Installat' n�Other F-1 Describe work: AD /Z- 'V%7L P�1-1 Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 3.00 Main service 100 AMP ORV OR LESS5.00 r Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING OCCUR.& OR ADDNS. ACC, BLDGS. 20sgft CONTRACTORS LICENSE LAW I declare under penalty of perjury one): p y p i y (check one : 19-11, 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. `37 4-19 Classification if - U 1 ❑ 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 NEWCONSTR U TI.OUTLET BRANCH CIRC ITS 2.50 ea NEWC ONSTFL POWER APPARATUS 8 NON.RESID, (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES $0@� BAL@1 FIXED APPLN5. OR Ex. Occup. (0UTLETS (REBID.) EA.1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 6.25. Permit Fee $ Contractor 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. 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. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. a G X Date Signature of Applicant — Owner'' Contractor ElAgent❑ 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 $_10-00 Land Development Fee $ TOTAL PERMIT FEE $ 50. OD OCCUP. GROUP I TYPE OF CONST. PARCEL PD I ND 99U This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIR R OF PUBLIC /. BY P IT EXPIRES Date _ the applicable provi- resolutions to do fees have been paid. WORKS Date, -_/// — -if e z Receipt No. 9/ I S Z WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT