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Home My WebLink About073-360-001073-360-001 02-3140 DUNN, DENNIS & CATHERINE' 19159 NEW YORK PLAT RD., FORBESTOWN REPLACE ELECTRIC SERVICE OFFICE Copy Address GAS Meter By Date ELECTRIC Meter By D a I . COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION ' , 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 _PEJ;40. (Rev. 12/96) APPLICATION AND PERMIT Z �f)�v ASSESSOR PARCEL NUMBER 023— 46NO01 ZONING BUILDING PERMIT OWNER IN TNN R rATuEgThm TELEPHONE SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING n P.O._2999=._k!9 CONTRACTOR'S NAME - '' TELEPHONE CONTRACTORS MAILING ADDRESS - CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 19159 MW YORK FIAT MY D iAT Energy Plan Checking Fee $ $ PERMIT FEE S LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee20.00 Each Trap 7.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Solar or heat um water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: REFUCE ELF:CIMIC SERVICE Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W 920.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 800V OR LESS Main Service .A OR 23.0015.b� 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. License Class Lic. No. 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 con ctors 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 I have and will maintain workers' compensation Insurance, as required by Section 3700 of 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.) ❑ 1 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. / ,� Date /� f '� �- Sig ure 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 TO , 46.00 NEW CONST. DWELLING OCCUP. SO WEI U OR ADONIS. & ACC. BLDS. 3.5¢FT; 97.50 IR NON -RE ID MULTI-OBRANCH UTLETrS POWER APPARATUS 8 SINGLE OUTLET CSI R. sop ,.00 Ex. Occup.OUTLET OR FIXTURES BAL p .50 Ex. Occup. FIXED TLTS a IES o OEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PR.C• 10Sp 25•60 PERMIT FEE $ 6,6.0 o 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 $ HAZ. I D. FEES IMP I FLOOD CDF PARCEL PO 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 fees have been paid. ' By Date i PERMIT EXPIRES ON /S//- I Date Receipt No. 'A<,41R Cr_c nn WHITE-D.D.S.-B.O. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT } COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDIN/DIION 7 County Center Drive. • Oroville, California 95965 • Telephone (530) 53 (Rev.12/96) APPLICATION AND PERMIT -114D. ASSESSOR PARCEL NUMBER 071- 360-001 ZONING BUILDING PERMIT OWNER T)l TW .OWNER'S MAILING ADDRESS P-0- BOX 27 FORBIESTOW. GA 9591-1 31 CONTRACTOR'S NAME TELEPHONE TELEPHONE SO. FT. OCC. BUILDING VALUATION CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAIUNG ADDRESS Total Valuation Is ARCHITECT OR ENGINEER UCENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS )MIRK 19159 NEW 9 FORBESTOWN Energy Plan Checking Fee $ $ PERMIT FEE _ LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF ❑ 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 ELECTRIC SFRVTCF Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W @20.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 LE Main Service zoOO.A OA OROR LESSSS 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. License Class LIC. NO. 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: ❑ I 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 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP. s0 OR ADDNS. ( a ACC. BLDS. 3.50 FT. NO.RESIDT' MULTI -OUTLET QG 7,50 POWER APPARATUS 8 SINGLE OUTLET CIR. Ex. Occup.OUTLET OR FD(TUREs 20 @ 100 BAL O .50 Ex. Occup. DFlx�eto�A R�DOEA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 ?VZ 10 s 23•&0 PERMIT FEE $ '(06.0o MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE S 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.) ❑ 1 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 l6.cic'+sr�sJ—l�h� l /�/�� /f�G7 Date �/ �� Signature of Applicant` -'O wn0 r Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $ HAz. D FEES IMP I FLOOD I CDF PARCEL PD HD ISSUE This permit is hereby sued under the applicable provisions to do work of th tte County ode and/or been in Gated for w ich fees have been aid. BY ate /� D PERMIT EXPIRES ON l� Se 3 Receipt No. -D.D.S.-B.DPINK-INSPECTOR GOLDENROD-APPLICANTWHITE CNAR t R