HomeMy WebLinkAbout078-180-050RUTH KILLGORE •
5328 Walmer Rd, Orc®,
(Permit #5663-78B(O rf�C o hip
goof, reroof) SF
}Contr: Fox Electric, Oroville
Permit #2214-79P,E,M(ele ser ch &.
inst. dual-pak) SF LoN
KILLGORE, Ruth PERMIL#95-297
5328 Walmer Rd., Oroville
Cont; George Roofing
Reroof/SF
o�B-18 �
0-
QO
. 4 .
036-176-008
P
ERMIT
#95-2978
1. KILLG0RE, Ruth
Orovillei 5328 Wr
Cont; George' Roofing , I/��/��•
R roof/SF-
4
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COUNTY. OF BUTTE'DEPARTMENTOF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County ,Center Drive - Oroville, California .95965 - Telephone (916) 538-7541 PERMIT NO.
APPLICATION AND PERMIT _
ASSESSOR PARCEL NUMBER / ..y� �
n //
ZONING
t
BUILDING RMIT
'OWNER _ O r �1
�1-05STELEPHONE
SO, FT. OCC. BUILDING VALUATION
/200 i o.Y)'
OWNERS MAIUNG'ADDRESS / �j
i + F' Ile .t <. Q�r
..
CONTRACTOR'S NAME � '
.,a c o� I ���
TELEPHONE
-G3g3
CONTRACTORS, MAILING ADDRESS ,/�� /
1e,,, 'Ile irl�i ��2' fi . CJII '/I�
Fireplace
p
CONSTRUCTION LENDS
UNI(NOWN
1
Total Valuation $
LENDER'S MAILING ADDRESS
t
Filing Fee $ 20.00
Permit Fee $
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $
Energy Plan Checking Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Penalty $
BUILDING ADDRESS w
1 G''
PERMITFEE $ y�� •�'"
:: .. r s :- r, ., t►..� d<.. ,. , �,�`,.::::� rT,,� M • . r «, -�_ 4. d rid+.rt
PLUMBINGPERMIT Filing Fee 20.00
a.'E�chaTrap�w.: ,�;► ;.z� t :1t� • z .E -0 7.00- ..c r
LOT NO.
_IUBD—IONS NAME
PARCEL MAP
Solar or heat pump water heater ,23.00
USE OF STRUCTURE }
SF ,KDuplex ❑ Mobilehome ❑ Other j
SPECIFY
Water piping 15.00
Each gas water heater`or vent 15.00
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: QLof %T t/
Mobile Home S G W @20.00
PERMITFEE $
Contractor
ELECTRICAL PERMIT Filina Fee 20.00
I
f
Main Service E00V OR LESS
( 200A OR LESS ) 23.00
Main Service ( 200A TO 1000A ) 46.00
LICENSED CONTRACTOR'S DECLARATION
I F e_reby'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 forceandeffect.
License Class [I / Lic. No. yea z le it
OWNER -BUILDER DECLARATION ;
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason: I
❑ 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.
❑ I am exempt under Sec: _ ,,Business and Professions Code.for.this •
reason '
NEW CONST. DWELLING OCCUP.SO.
OR ADDNS. ( & ACC. BLDS. ) 3.S¢ FT.
NEW CONST. MULTI -OUTLET
NON-RESID. ( BRANCH CIRCUITS ) @7.50
/ PONGLEWER APPARATOUTLETUS )
8 SICIR.
Ex. Occup. (OUTLET OR FIXTURES) BAL 20 Q 1.00 so
Ex. Occup. (OUTLE°Ts RESD.°EA) 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMITFEE s
='Co'ntractor
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 permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier _ 7L U 71-c (n /rz f4
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
-ventilation
PERMITFEE $
Contractor
... Policy.,Number J F2` -'.SCJ
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
R y�••,•�,--,t
1`0 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 Lfy�vlis t. //i n//�iJzl Date ��_.�%r��
Signature of Applicant - O Owner( Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee Is
Energy Inspection Fee Is
OCC
CONST. TYPE
TOTAL FEE $ /� --'
5
HAZ.
1 D. FEES
1
IMP
FLOOD
COF
PARCEL PD 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 / / YI// Date J
PERMITEXPIRESON• ('! %! / C/ 7%
I (Date)
Receipt No. 1"'1(�� � `
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISIO
7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO.
APPLICA�IONAND PERMITQ
ASSESSOR PARCELNUMBE.R ^ / QQ /
ZONING /
BUILDING RMIT
OWNER1
o h
TELEPHONE
S33 -,209S
SO, Fr, OCC. BUILDING VALUATION
/900 �n a,
OWNERS MAILING ADDRESS ® ��✓,/
CONTRACTOR'S NAMETELEPHONE
r o� 11 vl
-1,.393
CO MAILING ADDRESS �e9� / (�
� p dry v di �l�eex;,, y
lace
Fireplace
CONSTRUCTION LEND Ey
UNIOJOWN
Total Valuation $
LENDER'S MAILING ADDRESS
Filing Fee $
20.00
Permit Fee $
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $
Energy Plan Checking Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Penalty $
BUILDING ADDRESS
PERMITFEE $
PLUMBINGPERMIT
Fling Fee 20.00
Each Trap
7.00
LOT NO.
SUBDNISIOWS NAME
PARCEL MAP
Solar or heat pump water heater
23,00
USEOFSTRUCTURE
SF, Duplex ❑ Mobilehome ❑ Other
SPECIFY
Water piping
15.00
Each gas water heater or vent
15.00
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: OC /,z Lj
Mobile Home S G W
920.00
PERMITFEE $
Contractor
ELECTRICAL PERMIT
Filina Fee 20.'00
Main ServiceEOOV OR LESS
( 200A OR LESS )
23.00
Main Service ( 2..A TO I ... A )
46.00
` 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 0---347 Lic. No. 4�Z�
OWNER -BUILDER DECLARATION
1 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
NEW CONST. DWELLING OCCUP.
OR ADDNS. ( 8 ACC. BLDS. )
3.50 FSO.
T.
NEW CONST.MULTI.OUTLET
NON-RESID. BRANCH CIRCUITS )
97.50
( POWER APPARATUS )
8 SINGLE OUTLET CIR.
Ex. Occup. ( OUTLET OR FIXTURES)
20
50
EX. Occup. ( OUXTLETS RES D.ED )EA)
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PERMITFEE $
Contractor
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 permit is issued.
My workers' compensation i surance carrier and policy number are:
Carrier pert.
s�
MECHANICAL PERMIT
Fling Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMITFEE $
Contractor
Policy Number 09
(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
rthwith comply with those provisions.
e� ,✓
X Date=oGr%•-7J
Signature of Applicant - ❑ Ownertj9b Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee Is
Energy Inspection Fee Is
ocC
CONST. TYPE
TOTAL FEE $
JISSUE
HAZ.
I D. FEES
I IMP
I FLOOD
I COF
PARCEL PO
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.
B -(iQ Date
PERMITEXPIRESON—�7/c�C/
(p�eJ
Receipt No. 1
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
2ZILf- 1
j-3 z —WA CME P, s
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Oroville, California 95965
Tel ephoni.! 534-4*41
APPLICATION AND PERMIT
10�
0_01A- k f L L. (:y (JP A=
BUILDING
Owner " 1 _-•7,V"r_
SQ. FT. OCC. BUILDING VALUATION
Mailing Address
Telephone No.
Contractor rG V, C {_ C[ M I ,
Mailing Address 3C�Gt Lj �L1�fE ��Y,
Fireplace
Total Valuation
G �'�V I L s �` �ft • q s�
Telephone No.
73 - L-7-
3(,,
Permit Fee
J� �
Building Address ALSIG
Z W n _
Plan Checking Fee &/or Penalty
Permit Fee
PLUMBING No. @ FEE
PERMIT FILING FEE $3.00 UU
Each Trap 1.50
_
Ot2C0 L L_ L—
Repair drainage or vent piping 1.50
A. P. NO. �./ 76, --���
�Q.I
Zoning & Planning
Water piping 1.50
Each gas water heater or vent 1.50
FeesW:C.
I Sanitation
Fire Dept.
FireZone
Use Permit
Gas piping system 1 - 5 outlets 1.50
EQA
Parking
Plans
Parcel
Declaration
Parcel Map
60' R/W
Improvements
Each additional outlet .30
Building sewer 5.00
_Bldg:'Plans
Parcel A royal
Plans Approval
Lawn sprinkler system 2.00
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ❑
i
permit Fee $ 'Q.
F_ L L • S E 1211• C N Ilii. -a 11��_, TJ4 L_L_ELECTRICAL
No. @ FEE
PERMIT FILING FEE $3.00 3,00
00V OR LE
Main service 100 AMP ORSLESS 5.00 S.00
Single Family Duplex ❑ Mobil Home ❑ Others ❑
Main service EA. ADD•L 100 AMP 2.50
Main service OVERe00v 25.00
100 AMP OR LESS
Main service EA. ADD•L 100 AMP 1.00
NEW CONST. ( DWELLING OCCUP. ") 20sgft
OR ADDNS. 1 ACC. BLDGS.
CONTRACTORS LICENSE LAW
1 am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business &Professions Code under the name
style of, ''
NEW CONSTR. MULTI -OUTLET
NON-RESID. ( BRANCH CIRCUITS) 12.50ea
NEW CONSTR. (POWER APPARATUS 6
NON-RESID. SINGLE OUTLET CIR.
Ex. Occup{OUTLETS OR FIXTI,RES g L@;
Ex. Occup. (OUTLETSP(RESID IKEA) I 2.00 2.00
Temporary service 10.00
i
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $ /lp • .Z
$ / Cv �°
MECHANICAL No. @ FEE
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
a/I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
❑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 Workmen's Compensation Laws of
California.
PERMIT FILING FEE $3.00 3.00
Heating tao" 000 4. CU
7)6//I L P14 K-
Cooling �/7. T �, 0U
Ventilation
Hood 2.00
Permit Fee $
$ /% cc
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
Land Development Fee
$
TOTAL PERMIT FEE
$ 3�
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
r�
X �'r. /�-.. mit-=r-� Date
Signature of Permitee"oi Agent r01
i
Receipt No. J,
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte,County Code and/or resolutions to do work indicated
above fo`r which fees have been paid.
�+ i)
DIRECTOR -OF PUBLIC WORKS �^
By11��%15, pate
�yrw W F.>C, . -VL.V y r- 6,. 1
Building permit expires Date J ` "fin
':Q® i A L.
Owner
Mailing Address
Contractor �0 k
Mai Iing Address 3gel
O k:-Ov
Building Address G
i,
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Oroville, California 95965
9Tele0hone:%34-4541
APPLICATION AND PERMIT
L_
Telephone No.
CL ,ecm L
s OLIVE f+W Y
qSg t5°n�
I L4,
A. P. No. 7& —0 Zoning & Planning
es Con. Fire Dept. Fire Zone Use Permit
EQAI Plans Parking I Declaration P P Parcel Parcel Ma 60' R/W I Improvements
.Plans Rec'd I Parcel Approval I Plans Approval
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ❑
L.FG • '
bvPri,—
S v• Ci H-0 4. -4- (M-5 1 r r U,
AV.
Single Family .J Duplex ❑ Mobil Home ❑ Others ❑
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
License No. 306�� Classification
I am exempt from the Contractors License Laws of the State of California.
WORKMEN'S COMPENSATION INSURANCE
I am aware of the provisions of Section3700 of the California Labor
Codthich requires every employer to be insured against liability
for kmen's Compensation.
ave placed on file with the County of Butte a certificate of
rkmen's Compensation Insurance.
❑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 Workmen's Compensation Laws of
California.
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 i ctio urposes.
X Date-Y/'p 9
ig lure of Per r g t
/11 Receipt No.
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
_ BUILDING
SQ. FT. I OCC. I BUILDING VALUATION
Fireplace
Total Valuation
Permit Fee
Plan Checking Fee &/or Penalty
Permit Fee
PLUMBING
PERMIT FILING FEE
Each Trap
Repair drainage or vent piping
Water piping
Each gas water heater or vent
Gas piping system 1 - 5 outlets
Each additional outlet
Building sewer
Lawn sprinkler system
Permit Fee
ELECTRICAL
PERMIT FILING FEE
Main service 600V OR LESS
100 AMP OR LESS
Main service EA. ADD'L 100 AMP
Main service OVER 600V
100 AMP OR LESS
Main service EA. ADD'L 100 AMP
NEW CONST. / DWELLING OCCUP. 4
1.1
$3.00
1.50
1.50
1.50
1.50
1.50
.30
5.00
2.00
$3.00
5.00
2.50
25.00
1.00
FEE
. 00
Ex. OCCUDIOUTLETS OR FIXTIIRESFIXED LN S BALD 0�
Ex. Occup. ( OUTLETS APP
(RESID IKEA) 1 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 6.25
Permit Fee $1& -Ab
MECHANICAL N0.1 @ 1 FEE
PERMIT FILI G FEE $3.00 13. d0
Heating &01000 144 O 0
Cooling —F_ I I I `fr 0 I
55
Ventilation
Hood 1 2.00
Permit Fee $ /bad $
Land Development Fee $
TOTAL PERMIT FEE is 3/
This permit is hereby issued under the applicable provisions of
the Butt ounty Code and/or resolutions to do work indicated
above r hich fees ave been paid.
D F PU IC WORKS
BMl
Date
Building permit tsxpires Date ` `�L
PERMIT NO
5663-78B
_PERMIT EXPIRES
OWNER RUTH KTT,T,G0RF.
CONTR. owner
LOCATION (A.P. 36-176-8
5328 Walmer Rd, Oroville
Y.
{
{
Temp. Power Pole
Called PG&E
Temp. Elea Serv.
Called PG&E
Temp. Gas Serv.
Called PG&E
JOB
FINALED
(Date)
k1
(Sign tur .
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC'WORKS
BUILDING INSPECTION RECORD
BUILDING BUILDING (Cont'd) PLUMBING
Setback
Firewall
Soil Piping
Forms
Parapets
1st Floor
Main Bldg.
Restroom Finish
2nd Floor
Footings
Windows
3rd Floor
Stemwall
Siding
To out
Slab
Roof Sheathing -..S-7 S'
Water Piping
Piers
Roofing
Sewer
Garage
Fdn. Vents
Fixtures
Footings
Garage Vents
Water Htr.
Stemwal l
Insulation
Heaters
Slab
Carport
Footings
Prov. for physically
handicaped
Conformance of ex.
structure
Appliances
Gas PI in &Test
Tem .Gas
Slab
Final �� %
E Sanitation
Patio
FIREPLACE
Final
Footings
I Footing
ELECTRICAL
Masonry Walls
Throat
Rough
Reinf. Steel
Final
Fixtures
Bond Beam
/ FIRE SPRINKLERS
Motors
Stucco Final I Subpanels
Mesh MECHANICAL I Gird. Fault Prot.
Scratch Heating I Service
Brown Cooling ! Temp. Pole
Finish Ducts I Underground
Interior Lath Ventilation Permanent
Door Closer Final Final
MOBILEHOME UTILITIES ------------------ Elec_ Service Elec. Pedestal
Water Piping Sewer Gas Piping
MOBS HO dE INSTALLATION - - - - - - - - - - - - - - Support Elec. Continuity
Water Piping Drainage Gas Piping
DATE REMARKS OR C R ECTIONS
:;Lz4A I
�D/1JI7�
(NOTE: An entry must be made on this form each time you viElt the job site.)
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WO
7 County Center Drive — Oro'ville, California 95965
Telephone: 534-,4541
APPLICATION AND PERMIT
BUILDING
OwnerSO.
-T L L b 72
FT. OCC. BUILDING VALUATION
�ST vYl l'3 d—®U � 4:0 Z)
Mailing Address VJ
u ► ►. L, tr 5_91 L 67 A2,
Telephone No.
Contractor
Mailing Address
Fireplace
Total Valuation �pp , DD
Telephone No.
Permit Fee oil
Building Address ,53�g WALfy�E-M PA'
ng FeeB�/or Penalty
Permit t Fee
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00
Each Trap 1.50
eW—OU , J_L l
Repair drainage or vent piping 1.50
/
A. P. No. L t %� -�
Zoning $ Planning
Water piping 1.50
Each gas water heater or vent 1.50
) a Ion
I FireDept.
FireZone
Use Permit
Gas piping system 1 - 5 outlets 1.50
EOA
Parking
Plans
Parcel
Declaration
M
Parcel Map
60' R/W
Improvents
Each additional outlet .30
Building sewer 5.00
Bldg. ane Recd
Parcelproval
Plans pproval
Lawn sprinkler system 2.00
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ®
Permit Fee $
is
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
Main service 600V OR LESS
100 AMP OR LESS 5.00
Single Family ® Duplex ❑ Mobil Home ❑ Others ❑
Main service EA. ADD'L 100 AMP 2.50
`� DU �
/
Main service OVER a O 25.00
100 AMP OR LESS
Main service EA. ADD'L 100 AMP 1.00
NEW CONST. ( DWELLING OCCUP. 5i 2¢Sgft
OR ADDNS. ` ACC. BLDGS. /
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business &Professions Code under the name
style of:
NEW RESID.CONSTBRANCH CIR_-ET
T
NON-RESID, � BRANCH CIRCUITS) 2.50ea
NEW CONSTR. POWER APPARATUS a
NON.RESID. SINGLE OUTLET CIR,
Ex. Occup (OUTLETS OR FIXTI RES) g L 250
1
FIXED APP LNS. OR
Ex. Occup. OUTLETS (RESID•) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
�• I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
MECHANICAL No. @ FEE
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
c�certify that in the performance of the work for which this
permit is issued 1 shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
PERMIT FILING FEE J$3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
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
Land Development Fee
Is
TOTAL PERMIT FEE
$
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
l
X Date
Signature of P mi teegent
Receipt No.
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
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.
DIRECTOR F PU LIC WORKS
By Date qef
�Z�
Bui Ing permit expires Date c'z'S'� 7
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