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HomeMy WebLinkAbout072-610-010XT 72-29-80 WOODROW COLLINS ///�.�/� qi i 9409 Woodleaf Starc�ville Permit#2588-83E(ele ser ch/SF) r 8313 r MISCELLANEOUS - xElectric Panel fREPLACE ELECT PANEL (200 AMP)`,' .;155 BLACK BART RD BRANDY, WAYNE C & TINA', bib 15 k-:&ir}`°Raa d v�lle"�Slalne�l) - b { l y i r r • 3 ° r t T t t 1 - y BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION (IVR): (530) 538-4365 OFFICE: (530) 538-7541 FAX#: (530) 538-2140 ONLINE PERMIT/RENEWAL PAYMENTS: www.buttecounty.net\dds PROJECT INFORMATION_ Site Address: 155 BLACK BART RD Owner: Pelnlit NO: B0$-131$ APN: 072-610-010 BRANDT, WAYNE C & TINA Issued Date: 07/1.0/2008 By KCG Permit type: MISCELLANEOUS 148 CANYON HIGHLANDS Subtype: Electric Panel OROVILLE, CA 95966 Expiration Date: 07/10/2009 Description: REPLACE ELECT PANEL (200 AM (530) 533-6208 Occupancy: Zoning: A5 Contractor Applicant: Square Footage: GOODMAN SERVICES GOODMAN SERVICES Building Garage RemdVAddn P O BOX 4070 P O BOX 4070 YANKEE HILL, CA 95966 YANKEE HILL, CA 95966 , Other Porch/Patio Total (530) 538-9350 (530) 538-9350 FEE INFORMATION - DBE Single Phase Service-Resid $59.00 Total Charged: $59.00 Fees Paid: $59.00 Balance Due: $0.00 Receipt No: B7937 t.. LICENSED CO_NTRACT.,OR'S DECLARATION_ OWNER/, BUILDER DECLARATION Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License GOODMAN SERVICES 673423 / C20 C10 B C36 / 06/30/2009 Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed PERJURY that I am licensed under provisions of Chapter 9 I HEREBY AF NDER PEgfD* (cemmenci t n 7000 ion 3 of the Business and Professions Code, and my license pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000) is in full fo act. of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects 07/10/2008 the applicant to a civil penalty of not more than five hundred dollars [$500]; Please check one of the following: Cont ctoes 4ignature Date ❑ 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 WORKERS' COMPENSATION DECLARATION - " -- - — OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: the work himself or herself or through his or her own employees, provided that such improvements ❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR are notintended or offered for sale. If, however, the building or improvement is sold within one WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the year of completion, the owner -builder will have the burden of proof that he or she did not build or performance of the work for which this permit is issued. improve for the purpose of sale.). AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by EllSection Section ❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Professions Code: 3700 of the Labor Code, for the performance of the work for which this permit is issued. The Contractor's License Law dows not apply to an owner of the property who builds or improves My Workers' Compensation insurance carrier and policy number are; thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License Law.). Carrier: Policy Number. Exp. Date: - - (This section need not be competed if the permit is or one hundreddollars ($100) or less. ❑ I AM EXEMPT under Section B. & P.C. for this reason: 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 the Workers' = Compensat' La of California,and agre hat if I should became subject to the workers' X 07/10/2008 cempens pr sions of Se ' 3700 he Labor Code, I shall forthwith comply with those Owner's Signature Date provisio s. X 07/10/2008 __. ._ 1 hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and Stale laws relating to building Signat a Date WAR NG: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE injury, including death, and property damage caused by, arising out of, or in any way connected with HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND use or enc of any side Ik, street, or subsidewalk. I hereby authorize representatives of Butte ATTORNEY'S FEES. County nt he ab oned property for inspection purposes. I hereby certify that I am the Prope r or ed to act on the property ownefs behalf. CONSTRUCTION LENDING -AGENCY— ---� - — - �C 07/10/2008 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for I NaIne Of er ee IGN] Print Date the performance of the work for which this permit is issued. (3097 civ. code) ElOwner rE4, Contractor OR: Agent for Owner Agent for Contractor FILE COPY Lender's Address City State Zip BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION* OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION Website: www.buttecounty.net/dds PLEASE PRINT CLEARLY PERMIT NO. BIN # "When filed, this application and all supporting material becomes subject to the California Public Records Act. All public information related to this application is subject to public inspection and will be posted on the County's website for electronic access. OWNER INFORMATION Last Name? ONOIf' Fiat , e., N Mailing Address' ([I (�Ni aN N�� AND city ddul r KG State Zip S /,[' Ubu Phone �0 G % 6 Fax E-mail CONTRACTOR Name 6764440/tl q(- ✓JC6 Address 1 40-70 City c AMC(6 Nitc state C zip Phon . Sv Fax E-mail Lic. # !'�� t� Class GNATURE ARCHITECT/ENGINEER Name LK, T6 R p CGAIQ AC (G Address AJA 6 City No State Zip Phone Fax E mail State License Number GNATURE APPLICANT INFORMATION Name LK, T6 R p CGAIQ AC (G Address AJA 6 City No State Zip Fax E_mail PROJECT LOCATION AP# C) Property Address 15"5 &wl II city of r'iItte �6 WORKER'S COMPENSATION Policy Number N 'n Carrier 1i ► If hiring anyone other than licensed contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address DESCRIPTION OR SCOPE O ORK. Law, t QAC �Ce ANE( 11 Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning Flood Zone SRA I Yes I No Occ. I Type Const. ., ...-c�:•t`c^,ya�„�-„yy}.;�,p;� N,;!`:'�*,dal,:'_ '+" °�t.;�q `�;nr++;y-✓:Y'r �l �. �:. .^r'.. .-. .. y-, ... y_ ts' Woodrow Collins . Permit #2588-83 9-e3 77 t ' k COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT OWNER* I ' � TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS " 1 CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILDING ADDRESS PLUMBING PERMIT Filing Fee 10.00 + r e, I is 4 ' ` �' Each Trap 2.00 Solar Water Heater 20.00 - �, +? Water piping 5.00 LOT NO. SUBDIVISION NAMEPARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF ❑ Duplex ❑ Mobi lehome ❑ Other SPECIFY Building sewer 5.00 Mobile Home I S1 GJWJ 10.00 e TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities Q Installation❑ Other ❑ Describe work: _ i _ . % L�. r: f Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 1000V OR 0 AMP ORLESS10.00 _ Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING OCCUP.& OR ADDNS. ( ACC. BLDGS. 2I/20sgit 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 Q 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. ULTI-OUTLET 2,50 ea NON.RESID BRANCH CIRC ITS NEW CONSTF POWER APPARATUS ' SINGLE OUTLET CIR. NON-RESID. ( & Ex. Occup(OUTLETS OR FIXTURES a°L® oc d FIXED APPLNS. OR Ex. OCCUp. OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 _� J. f Y Permit Fee $ 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. ❑ 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 shal I be deemed revoked. 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 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. X '�=' /�il'� ! ��►- f Date - Signature of Applicant �r — Owner❑ 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 $ TOTAL PERMIT FEE $ j 'I , O OCCUP. GROUP I TYPE OF CONST. I PARCEL PD I HD I ISSUE - ' This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF PUBLIC By > �r PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date, Y '� . f. Receipt No. WHITE-D.P.W., YELLOW-ASSCSSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT PERMIT NO. d _O ASSESSOR PARCEL NUMBE 72 _. 2 -BUILDING ZONING PERMIT OWNER woo ' TELEPHONE S0. FT. OCC, BUILDING VAL TON OWNER'S MAILING ADDRESS a e_,eosr em, -o CONTRA TOR'SNAME JTELEPHJDNE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee ,$ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILDING A DR S Q �OD.b PLUMBING PERMIT Filing Fee 10.00 1:57-h -6//L6-9'r6-1-0-tn o6C Each Trap 2.00 Solar Water Heater 20.00 7-6 849 .# Water piping 5.00 Lo NO. SUBDIVISION NAMEPARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF I, Duplex ❑ Mobi lehome ❑ Other SPECIFY Building sewer 5.00 Mobile Home S G W 10.00 e TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities'X Installation❑ Other Describe work: aLd_=�E 0/C°C &W6 Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 ©®p Main service EA. ADO'L 100 AMP 2.50 -65D NEW CONST. DWELLING OCCUP.& OR ADDNS. ( ACC. BLDGS. 2/22sgft 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 m license is in full foe and effect. Y nforce 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. ULTI-OUTLET 2.50 ea NON-RESID BRANCH CIRC ITS POWER APPARATUS 9 NEW NON-RESID. CONSTR.SINGLE OUTLET CIR. / ( 200500 Ex. Occup(OUTLETS OR FIXTURES SAL@300 EX. Occup. OUTLETSP(RESID )REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 15100 Permit Fee $ Contractor 5125 MECHANICAL PERMIT FiIingFee 10.00 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. Heating Cooling Hood 3.00 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 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 id Count in cons a of the granting of this permit. - C.I Date Signature of Appli — Owner ❑ Contractor ❑ Agentz 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 $ TOTAL PERMIT FEE $ OccUP. GROUP I TYPE OF CONST. I PARCEL PD I ND 1550E This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRE R OF PUBLIC BY PJAIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date-F_?—P:? ���� Receipt Na61�� WHITE-D.P.W.• YELLOW-ASSFSSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT 055 e COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION - 7 COUNTY CENTER DRIVE - OROVILLE,aCA-01F,`0R1\1IA 95965 - TELEPHONE: 916/534-4541 . PERMIT APPLICATION DATA SHEET Permit No. OWNER 1.l).i®-1&.l.e :2 A. P. No. -7Z�Z%� W Proposed Building Use Permit Fee Based Upon: Complete Contract Price DPW Valuation Other -(Explain) Building Inspector Date At time of permit application, I was advised the following data 'must be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED 1, All items have been submitted. . . . . . . . . . . . 2. Plot plans in duplicate./triplicate. . . . . . . . 3. Complete plans in duplicate. /triplicate. . . . . . . 4. Complete engineered plans and calcs. . . . ... . . . . 5. Plans with Energy Design Compliance Statement. . . . . . 6. State Energy Forms No. 7 Statement of Intent for Non -Heated and AC Buildings. _ 8. Fees of $ 9. Letter of signature authorization.3 10. Sanitation approval' from Health Dept. 11. Planning approval for (A) Use: (B) Parking: 12. Certificate of Workmen's Compensation Insurance.:• . 13. Contractor's License Information (no., name style, classif,) 4. Owner -Builder Verification (Given to owner0, Mail to owner ✓) £i 15. Improvements may be required. , , , , , , , 16. Mobi lehome Installation Data. . . . . . . . . •Pre-Inspec. request to 7. Pre -Inspection forRequired. Building Inspector (Dote) 18. Other When you issue the permit, process as follows: Mail to owner. ------.:.Mail to contractor. '�-c Telephon_z�s��Z5 and hold for pickup at office. Deliver w/inspector. Other Applicant [Z�s! Date Copy of plans sent Health Dept., Fire Dept., Other + Date During the plan checking process, the following data must be submitted prior to permit issuance: (For required items not checked above at time of application, circle item.) 1. Index permit for above Items No. 2. Additional items required: (Contractor, Designer, Owner) was advised of above required data by Telephone Plans checked by. Plans approved by Other: Copy—DPW Mail Other By Date Date Date COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT ASSESSOR PARCEL. NUMB E 2 _� 2 ZONING BUILDING PERMIT OWNER �OO ..11L J TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWI,JER'S MAILING ADDRESS CONTRACTOR'S NAME /l—J — TELEP' NE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILDING A DR 5 0 LUOO. 44-=51P 10t, PERMIT Filing Fee 10.00 -5-1—Wk `` ��, f� •'- 5 � _ D� = A) L&FP?- Q--f-P B� '� Each Trap 2.00 Solar Water Heater 20.00 Water piping 5.00 LO NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 _ USE OF STRUCTURE SF Du;;lex❑ Mobilehome❑ Other SPECIFY Building sewer 5.00 Mobile Home Ts—T­G1w1 10.00e TYPE OF WORK New ❑ A.ddition ❑ Remodel ❑ UtilitiesV Installs, ❑ Other Describe work:- L�`%Q( �E� 0� fJ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 ain service 1 100V DR00 AMP OLOR R LESS 10.00 D Op i P/ -- In Service EA. ADD'L 100 AMP 2.50NEW 2 OR ADDNS. ACCLBLOGS.LING CCUP.&) 1/20SQft — ONTR TORS LICE SE W I declare unde ty perjury ( h On ) E]I a lic Sed unde ovl i hapt. , i of the Business and fessions C de an y I se Is I f force and effect. License No. I S ficatlo .01 I, as the owner, o y p es wit wages as th it sole compen- sation, will do the or n the struct re is not intended or offered for sale. (Sec. 7044 ❑ I, as the owner, a clusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. Business and Professions Code for this reason NEW RESI0. U NCH T LET NON .RESID. BRANCH CIRC ITS 2.50 ea CIRCUITS) NEW CONSTR (POWER APPARATUS &\ NON-RESID. SINGLE OUTLET CIR. / Ex. Occup OUTLETS OR FIXTURES 9A @300 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 — - Permit Fee $ Contractor S�,S MECHANICAL PERMIT Filing Fee 10.00 WORKMEN'S COMPENSATION INSURANCE 1 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 MW I 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 id Count in cons e f the granting of this permit. ' Date`! Signature of Appli — Owner El Contractor ❑ Agent.W 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 $ TOTAL PERMIT FEE $ $�2,L5-Q occuP. GROUP I TYPE of CONST. PARCEL PD ND I ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF PUBLIC By By PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date Receipt No. WHITE-O.P.W., YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT �ti�,.--. or DEPT. OF PUBLIC WOai(S -AUG -© g 1983 COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville., CA. 95965 Phone: 916-534-4541 A 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 in the envelope provided at your earliest opportunity to avoid unnecessary`delay in processing and issuing your build- ing 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) 6 S. 2. I (have/have not) W,4VI�6LZ 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: 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 ,R14 T/R/CK :5. Q61. I_ )nLS (916) X77--3 517:5 4k19C? 1R S ign Social Security number Date 8 — -- g3 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 permitted to issue the .permit.