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Home My WebLink About078-200-001L. J. DENNEY 5512 Farley St., Oruville DENNY, Lee 3437B -"117 C ONTR: Pryor Contracting$ Oroville ; 34"B* + Permit 244.8-738 7 11$ �- __(rer000f) 5512 Farley St., Oroville Contr: George Roofing CONTR: West Coast Home Products, 815 S.Fx PErmit#1505-87B(reroof/SF) 4P7 (alum. siding) Alhambra' a ' *addition 05-0444 DENNEY, LEE '3^ 5512 FARLEY ST, OROVILLE �) I Cont: ALLADIN ROOFING" 9 REROOF i 1 a BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BPO50444 B. C. Building Permit 01-16-04 pq 1 LICENSED CONTRACTORS 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 Issued Date: 02/15/2005 APN: 036-370-001-000 the Business and Professions Code, and my license is in full force and effect. License Class: 0 9 License Number: "y Site Address: 5512 FARLEY ST ORO Date: 2-4r�-405_ Contractor: : ,it o �r Map Index: Description: RE ROOF 16 SQ OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a Owner: DENNEY LEE J & MILDRED permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a 5512 FARLEY ST signed statement that he or she is licensed pursuant to the provisions of OROVILLE, CA the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or 95966 she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 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 (Sec. 7044, Business and Professions applicant: ALLADIN ROOFING Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, P O BOX 4262 provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one OROVILLE, CA 95965 year of completion, the owner -builder will have the burden of (530) 533-2934 proving that he or she did not build or improve for the purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does Contractor: ALLADIN ROOFING not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). P O BOX 4262 ❑ 1 am Exempt under Article 3 of the Business and Professions Code OROVILLE, CA 95965 (530) 533-2934 Date: Owner: License #: 532834 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 Architect: is issued. Engineer: I have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: F".—Cl Carrier:c--T44,fe Total Square Ft: 0 S. F. Policy #: / 13- 19 -77-y S Valuation: $0.00 Census Code: ❑ 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' compensation laws of California, r 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: Applicant: WARNING: Failure to- secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one n addition to the cost of hundred thousand dollars provided for compensation, damages as provided for in Section 3706 of the Labor 2— code, interest, and attorney's fees. �VIIEI� CONSTRUCTION LENDING AGENCY This pe is hereby iss d th ppli ble provisions of the Butte County Code and/or 1 hereby affirm that there is a construction lending agency for the of the work for which this permit is issued (Sec 3097 Civ.) Resol ns to do wor nidi ted ove fo hich fees have been paid. performance By� Date: Name: PERMIT EXPIRES ON: Address: Date I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. � Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representa/'ves of Butte o/ty to er upon the above mentioned property for inspection purposes. Print Name: 1 Signature: ��5' Date: ❑ Owner �' Contractor ❑ Agent for Owner ❑ Agent for Contractor B. C. Building Permit 01-16-04 pq 1 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" OWNER Last Name�G yVN irst Address City Gid/ �/ State �. Zip 6 Phone Fax E-mail APPLICANT NAME CONTRACTOR Name City Address & 2 Cityowx Fax Stateea ZipCf( S Phones3 3_, Lot # Fax E-mail Lic. #Class i��-32S 5 YF APPLICANT NAME ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Lot # Fax E-mail State License Number APPLICANT NAME Name (� C� Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X For office use only: Zoning Property Address SS19 Flood Zone Cross Street SRA I Yes I No Occ. Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc PERMIT NO. BP05-0 y V BIN # LOCATION AP# G -7� 769 ^c-90 9 / Property Address SS19 City Cross Street WORKER'S COMPENSATION Policy Number / [.._r. C{ Carrier If hiring anyone other than license contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Page 1 of 2 Description or Scope of Work: P.tv o t -c. Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be required. REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Received by: — Amount: /V Bldg SRA Receipt #: � Sheriff SMIP Other Date: 1 S/0 Total REV 7-27-04 SUBMITTAL & PERMIT REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply for a permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper! ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR Engineered plans, 3 or 4 sets, .with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. Engineered truss details and layouts in duplicate (if required). No faxes! ❑ 4. Energy compliance,design and supporting documentation in duplicate. (Note: Not required for additions to mobile or modular homes.) ❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 6. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 7. Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 8. Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required). ❑ 9. Site plan and business license approval from the City of Biggs. ❑ 10. Letter of intent for non-residential buildings. ❑ 11. Detached Accessory Building Form filled out by the owner (if required). ❑ 12. Hazardous Material Form (for Commercial Buildings only). ❑ 13. Sanitation and site plan approval from the Environmental Health Department. Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning review (May require additional plan review upon receipt of the following items.) ❑ 1. Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required). ❑ 2. Impact Fees. ❑ 3. California Department of Forestry plan approval (if required). ❑ 4. NPDES Form. ❑ 5. Encroachment Permit for driveway from the Public Works Dept. (construction approval prior to occupancy). ❑ 6. Contractor's license information. (Number, Name Style, Classification). ❑ 7. Worker's Compensation Carrier and Policy Number. ❑ 8. Owner -Builder Verification (if required). ❑ 9. Letter of Signature authorization (if required). ❑ 10. Recorded copy of Agricultural Acknowledgment Statement. ❑ 11. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's). If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530)538-7541. EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR FEE REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made within two years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. OVER FOR BUILDING PERMIT APPLICATION KIFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04 i� 4. Permit#1505-87 Lee Denney 5512 Farley, Oro COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Orovilley"Galifo''hia 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT PERMIT NO.. / 154s-�7 ASSESSOR PARCEL NUMBER '•J, % % (J ZONING BUILDING PERMIT OWNER Loa' O��}' Jc nnr V TELEPHONE 533-0553 SO. FT. OCC. BUILDING VALUATION I, it, tit OWNER'S MAILING ADDRESS !):j 2 : cirley Oroville CONTRACTOR'S NAME Coorgo Roofing TELEPHONE 533-6393 CONTRACTOR'S MAILING ADDRESS P.O. Box 729 Oroville 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 ADDRESS Penalty $ BUILDING ADDRESS 5:312 Farley Permit fee $ �� PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 - 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 a Duplex❑ Mobilehome❑ Other 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 ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other[g] Describe work: Roofing L1 1 1/11( `1 (.= V n IiF _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service i$D1 OR o AMP ORLESS10.00 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. 152266Classification—�9 ❑ 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.tr ,h¢sgft OR ACDNS. ACC. BLDGS. NEW CONSTR.MULTI-OUTLET NON- ESI BRANCH CIRCUITS 2.50 ea POWER APPARATUS tr %SINGLE OUTLET cIR. EX. Occup(OUTLETS OR FIXTURES 200a0t e ALO 30 FIXED APPLNS. R Ex. Occup. OUT LETS IIRESID.)EA.1 2.00 Temporary service 10.00 , Mobile Home Facilities 15.00 Misc. �Virin 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. 0 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 FiIingFee 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. 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. ./ 5-5-87 %� '� *s Date Signature of Applicant — Owner E] 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 $ Energy Inspection Fee $ TOTAL PERMIT FEE $ occu P, CON5T,TYPEJ �FL0001PARCELI PO I ND I ISSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. / DIRECTORiOF PUBLIC'WORKS r' j By / �•• .,s� Iik��y Date PERMIT EXPIRES Date /X' Y Receipt No. rf WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR, COLDENROO-APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, G`ali.fornI,9 95965 - Telephone 916/534-4541 APPLICATOR ANDIPERMIT "_1 PERMIT NOf ASSESSOR P R EL UMBER // ZONING 1 BUILDING PERMIT OWN R Lee y enn TELEPHONE 533-0553 I SQ. FT. OCC. BUILDI G VA UATION , OWNER'S MAILING ADDRESS 1 5512 Farley Oroville 1600 CONTRACTOR'S NAME George Roofing TELEPHONE 533-6393 CONTRACTOR'S MAILING ADDRESS P.O. Box 729 Oroville Fireplace CONSTRUCTION LENDER UNKNOWN LENDER'S MAILING ADDRESS Total Valuation Is Filing Fee Permit Fee $ 10,00 $ ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee Plan $ ARCHITECT OR ENGINEER'S MAILING ADDRESS i Energy Checking Fee Penalty $ $ BUILDING ADDRESS 5512 Farley Permit fee $ i PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 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 [2 Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S I G I IN 0.00ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ liti�❑ Inst Alation❑ OtherR] Describe work: Roof ing I Q ic VSA tml _ Permlt Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 100 AMP OR001 OR LESS10.00 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. 452266 Classification C-39 ❑ 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) ElI, 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.Iti , OR ADDNS. ACC. BLOGS. iosgft NEW CONSTR. ULTI.OUTLET 2,50 ea NO N.R ESID BRANCH CIRC ITS (POWER APPARATUS e) SINGLE OUTLET CIR. ot 20 Ex, OCCU @ p OUTLETS OR FIXTURES 5ALeALo303o Ex. Occup. OUTLETS P(RESID IRE A.) 1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 9 15.00 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. 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 sai County in consequence of the granting of this permit. X Date 5-5-87 Signature of Applicant — Owner ❑ Contractor ❑ Agent 1:3 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 $ CJ��S OCCUP, CONST.TYPE I FLOOD PARCEL PO ND ISSUE This permit is hereby issued under sions of the Butte County Code and/or work Indic d above for which IREC F PU BY PERMIT EXPIRES Date the applicable provi- resolutions to do f s have been paid. WORKS Date Receipt No. WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT 14 1861 s abz,30/76, rt ,�b� zn3 /76, . I 0 PERMIT NUMBER - B24-44 •8-73R P E 1 PERMIT EXPIRES 0 -7 y- OWNER L.J. Denney -YCONTR:*.Pryor Contrcting, Oroville LOCATION (A.P. 36--37-1 5512 Farley St., Oroville T COUNTY OF BUTTE Department 'sof .Public Works BUILDING INSPECTION RECORD Zoning Setback Forms Foundation Piers & Girders Fireplace Rgh. Plumbing Bond Beam Lath & Plaster Rein. Steel Gas Piping & Test Found. Vents Framing Plmg. Topout Rough Elec. Wtr. Htr. Fum"ace Kitchen Vent. Firewall Garage Vents Sanitation & Water ELECTRIC GAS BUILDING Temporary Temporary Cert. of Occup. Final Final Final DATE REMARKS OR CORRECTIONS COUNTY OF BUTTE — DEPARTMENT OF PUBLIC 7 County Center Drive — Oroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT WORK 1� ? 73� authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X Date ign r of ermi or�ent Receipt fV 12 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 OF PJABLIC WORKS ByDate 7 /'- - 7a wilding permit expires Date? -Q-?X BUILDING Owner -SQ. FT. OCC. BUILDING VALUAT ON d0. Mailing Address S^ , � Telephone No. Fireplace Contractor V, Total Valuation Mailing Address( s , T�, _ �a Permit Fee Plan Checking Fee&/or Penalty elephone No. Permit Fee $ $ .> Building Address Zi4 PLUMBING No. @ FEE PERMIT FILING FEE $2.00 r Each Trap 1.50 Repair drainage or vent piping 1.50 ,Water piping 1.50 Each gas water heater or vent 1.50 A. P. No. ApGj — `, 1 Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 F .C. 3af1lT n I Fire Dept. FireZone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration parcel Ma P 60' R/W Improvements p Lawn sprinkler system 2.00 Bl�gd"�P anl—s pec d Parcel Approvol Plans Approval Permit Fee � $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER Qd ELECTRICAL No• @ FEE PERMIT FILING FEE $3.00 or) 04 12 k4t I Main service incl. 1 meter Additional meters, each 1.00 Sub -panel (12 or less) (more than 12) Single Family Duplex ❑ Mobil Home ❑ Others ❑ Range, Cook -top or Oven 1.00 Water Heater or Space Heater 1.00 Light fixtures bal__1(al0 Receps., switches & fix outlets Zooms 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: C J Hood, Ex. Fan or F.A. Furn. Motor 1.00 Evap. cooler, gar. diso. or D.W. 1.00 Air conditioner or heat pump Water pump Mobil Home Facilities 5.00 Temp. Power Pole 5.00 License No._aL % I VClassification 6? —31 Misc. wiring ❑ I am exempt from the Contractors License Laws of the State of California. Permit 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. 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. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating. Cooling Ventilation Hood 2.00 Permit Fee $ $ 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. TOTAL PERMIT FEE $ , authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X Date ign r of ermi or�ent Receipt fV 12 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 OF PJABLIC WORKS ByDate 7 /'- - 7a wilding permit expires Date? -Q-?X