HomeMy WebLinkAbout073-170-047Ll
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' 73-17-1W
FOOTHILL FIRE PROTECTION ASSOCIATION IN
400' off S/S Oro Forbestown Rd, opposite
Sunset Hill Lookout Rd, Forbestown Area
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1968-85E
Foothill Fire Prot. Ass(
Forbestown Rd,
OFFICE COPY
Address
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COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS .
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION AND PERMIT
PERMIT NO.
i
ASSESSOR PARCEL NUMBER
ZONING
BUILDING PERMIT
OWNER , \ �-TELEPHONE
Vi
..,.1
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
CONTRACTOR'S NAME /
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER +�_
NV i`
UNKNOWN
Total Valuation $
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER l
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS f"' I
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
• ` �, �� _ -� t� �� ti r ) ., ��
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 ❑ Du lex Mobilehome Other��.
p ❑ ❑
I SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
10.00 ea
TYPE OF WORK
New [_1 Addition ❑ RemodelUtilities[:] dnstallation❑_.Other E-'
r -
Describe work: - C.? c, x i FJ I
.. 11I n E� rl>1y �� r t
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
`I ~h1 .j •7 �, 1
6OOV OR LESS
Main service 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 force and effect.
License No. Classification
❑\,EX.
, 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)
❑ 1, 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 OCCUPM
OR ADDNS, ACC. SLOGS. , /20sq ft
NEW CONSTF ULTI.OUTLET G
NON.RESID aRANCH CIRC ITS ._. 2.50 ea (4:?�•
'
POWER APPARATUS 6)
SINGLE OUTLET CIR.
Ex. OCCup(OUTLETS OR FIXTURES 20050t
eALa30
OCCUp. OUTLETS ((RESID ) FIXED APPLNS. REA.1 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
9
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
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 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.
XI ` 1, / `/,
Signature of Applicant — Owner El i Contractor E]Agent [Q
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 $
TOTAL PERMIT FEE
occuP,
CONST.TYPEJ
FLOOD
PARCEL
I PD
HD
SsuE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOF dF PUBLIC
1 J
By .�
PERMIT EXPIRES Date/
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date
Receipt No. o C.
WHITE-D.P.W., YELLOW-ASSE330R, PINK -INSPECTOR. GOLDENROD -APPLICANT
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V COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION AND PERMIT
PE MITr
ASSESSOR P RCEL UMBER
ri Jr j , I I
ZONING
• BUILDING PERMIT
o 2X9 R
DWU%1\r
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
NER'S MAILING ADDRESS
f 1
CONTRACTORSNAME
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
$ '
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADD ESS
Penalty
$
BUILDI G ADDRESS _�� r�
Lf &C1
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
LN
Each Trap
2.00
J — Y
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 STRU URE
SF ❑ Duplex.❑ Mobilehome❑ Other �,2[_�aa-
SPECI FY
Gas piping system 1 - 5 outlets
1.5.00
Building sewer
5.00
Mobile Home S I G I W
10.00 ea
TYPE OF WORK
New ❑ Addition Remodel ❑ Utilities ❑ Installation IOther
Describe work: -
,r
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Brr I�M,
Main service 10Dv OR LESS
100 AMP OR LESS
10.00
Main service EA. AOD'L 100 AMP
2.50
CONTRACTORS LICENkAfAW
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.
1 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 CONST. DWELLING OCCUP.ty� 1b0sgft
OR ADDNS. ACC. BLDGS.
NEW CONSTR. MULTI -OUTLET ea
NON.RESID BRANCH CIRC ITS
POWER APPARATUS e�
SINGLE OUTLET CIR.
Occu / U200e0c
Ex.p\OTLETS OR FIXTURES BAL030 '
Ex. Occup. our OUTLETS (RR
ESID IEAJ 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
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
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.
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
aga�ai ty in con a uence of the granting of this permit.
X Date<ak
Signature of Applicant – Owner C tractor ❑ Ag.dqZ
An OSHA permit isrequired 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 $
TOTAL PERMIT FEE $
Occup.
CONST.TYPE
T7LOODI
PARCEL
I PD
I ND
I ISSUE
This permitis hereby issued under
sions of the Butte County Code and/or
work indicated above for which
F PUBLIC
By
PERMIT EXPIRES Dat
the applicable provi-
resolutions to do .
fees have been paid.
WORKS
Date
Receipt No. �IL (Pp 9
WHITE-D.P.W., YELLOW-ASSr3SOR, PINK -INSPECTOR, GOLDEN ROD-APPL I CANT
�.:1L�.i�l•�, '` _ X7�:;:.iTti �::!: ..:•!Y 1 v !:� t:Y'D.f'� ..� ..::......
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; N 89° 35' 32" E _ N 89° 35'32" E 400.00'
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i 152.42'
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EASEMENT`+
PLUMAS
4T.' 'FOREST
144 ACRES
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