HomeMy WebLinkAbout078-210-049Duard Millet
5289 Walmer Rd., Oroville
contr: Acro-Lume, 0 0 le
Permit #1975-77B�-nMYX'ing/SF)
ContR: George Rfg
PErmit#3416-88B(reroof/SF)
056-958 949 PERMIT#95-2335
MILLET, Duard..
5289 Walmer Rd. ,-Oroville
Cont; George Roofing
�.Reroof/SF 71'Oe ��'&- —) -
�MILIET, Duard 1227B
lo7
5289 Walmer Rd., Oroville
1-2
81
O Q , , _ _ .., �!�
/101
/.' J -Du iii
OROVILLE, CALIFORNIA
GENERAL CLAIM
CLAIMANT: Don C. George Inc
ADDRESS: P.O. Box 729
CITY & STATE: Oroville, CA 95965 IMPORTANT:
.Tune 6, 1989 SEE INSTRUCTIONS
DATE OF CLAIM: ON REVERSE SIDE
SUBMIT CLAIM TO DEPARTMENT RECEIVING GOODS OR SERVICES
DATE I DESCRIPTION OF CLAIM (DESCRIBE FULLY TO AVOID DELAY) I AMOUNT
MR. MILLET TRIED TO GET FINANCING FOR THE R.EROOF
AND WAS UNABLE TO, HE NOTIFIED US FINALLY THAT HE
COULD NOT HAVE TH
REQUESTING A REFUND OF THE PERMIT AMOUNT.MINUS THE
$10.00 FILING FEE.
Owner has decided not to do work. (Bldg Permit Appin. X344`16 -88B
Receipt #26946, dated.10/11/88, A.P. #36-35-49). Owner: Duard Millet.
Du_L_Lu_Lng permir Lees Pala---------------------- $38.00
Retain filing fee ------------------------------ $10.00
TOTAL REFUND DUE
---------------------------------------- 28.00
_ $28. 00
I TOTAL I $2
I. the undersigned, declare under penalty of perjury that the services or articles claimed have been erfonned or delivered, and that this
claim is true and correct as stated.
Dated this �,//'�, ; ;�
.................................. day of ............ 19� at(Y.C:Gfi'l:GL".C.Sf. Calif. / �f-�'-•r.'• ...
Signature of Claimant s
I, the undersigned, hereby certify that, to the best of my knowledge, the services or articles specified above have been performed or de-
livered and that there is a Budget Appropriation or Specific Board Approval (Check one) for
Dated this •,,,•,,,,,,,,,,, 6th day of June 19 89 a Oroville
t ................. . Calif.
Dog`' 440-002 coati 4210500
Code ............................................ 2
DEPT. & SUB. I PROJ. I SUB. OBJ
apartment Head or Authorized Dep
................PAYABLE FROMConst!Permits
........................................................................FUND
....................
LOW THIS LINE - AUDITOR'S USE ONLY
CLAIM NO. INV. NO. INV. DATE ENC MB'. GROSSAMT
I I I
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 Jv(
APPLICATION AND PERMIT
ASS�SOR PARC L N B
ZONI
BUILDING PERMIT
OWNER
TELEP ONE
33-4957
SQ. FT. OCC. BUILDING VALUATION
t—u
17ull1 p
Y
OWNER'S MAILING ADDRESS
5289 WALMER AVE. OROVILLE CA.
CONTRACTOR'S NAME
DON C. GEORGE INC.
TELEPHONE
533-6393
CONTRACTOR'S MAILING ADDRESS
P.O. BOX 729 OROVILLE CA. 95965
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$ 2 97. TO -
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
,$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
5289 WALMER AVE, 0 OVILLE CA.
Permit fee
$ 38.00
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 [R Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
10.00ea
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other [�
Describe work: PSE Ro gy A1111 T_11P RGOP
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 6001 OR LESS
100 AMP OR LESS
10.00
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (Check one):
® I am licensed under provisions of Chapt. 9, Div. 3 of the BuslnesS
and Professions Code and my license is in full force and effect.
452266 C-9
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)
❑ 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
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. DWELLING OCCUP.61 ,
OR ADDNS. ACC. BLDGS. /20sgft
NEW CONSTR. M U TI.OUTLET
ITS 2.50 ea
NON.RESID .BRA CH CIR_U,
POWER APPARATUS tr
(SINGLE OUTLET CIR.
EX. OCCUp�OUTLETS OR FIXTURES 209600
eAL9so
Ex. Occup. OUTLETS P(RESID.IREA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring
g 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 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
against sai ounty in conseqyence of the granting of this permit.
X Date 10-11-88
Signature of Applicant — Owner EDCl ontracror ® 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 38.00
OCCUP.
CONST.TYPEJ
SCHOOL
I FLOOD
PARCEL
I PD
HD 39UE
This permit is hereby issued under
sions of the Butte County Code and/or
work i d above for which
IRECr PU
B.
P MIT XPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
IC ORKS
M 10
D to
Receipt No.
WHITE-O.P.W.. TELLOW-ASSE330R. PINK -INSPECTOR, GOLDENROD -APPLICANT
8861 Irl
t
PERMIT NO. 1975-77B
PERMIT EXPIRES
OWNER Duard Millet
CONTR. Acro-Lume, Oroville
LOCATION (A.P. 36-177-7
5289 Walmer Ave., Oroville
Temp. Power Pole
Called PG&E
Temp. Elec. Serv.
1
1e
Called PG&E
j
Temp. Gas Serv.
Called PG&E
r
�.
` /JOB �]
V JOB
( e
�(Si �,e)
Stucco
COUNTY OF
BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION RECORD
Mesh
ILD;G
B ILDING (Cont'd)
I PLUMBING
Setback
Service
Firewall 1
1 Soil Piping
Forms
Finish
Parapets /
1st Floor
Main Bldg.
Ventilation
Restroom Finisil
2nd Floor
Footings
Final
Windows
3rd Floor
Stemwall
Water Piping
-Siding
To out
Slab
Support
Roof Sheathing
a Water Piping
Piers
Gas Piping
Roofing
Sewer
Garage
Fdn. Vents
Fixtures
Footings
Stem wall
Garage Vents
Insulation
Water Htr.
Heaters
Slab
Carport
Footings
Prov. for phsically
handicap e.
Conformance of e .
structure
Appliances
Gas Piping& Test
Temp. Gas
Slab
Final
Sanitation
Patio
FIR PLAC
Final
Footings
Footing
ELECTRICAL
Masonry Walls
I Throat
Rough
Relnf. Steel
Final
Fixtures
Bond Beam
n /I
FIRE SPRINKLERS
Motors
Stucco
Final
Subpanels
Mesh
MECHANICAL
Grd. Fault Prot.
Scratch
Heating
Service
Brown
Cooling
Temp. Pole
Finish
Ducts
Underground
Interior Lath
Ventilation
Permanent
Door Closer
Final
Final
MOBILEHOME UTILITIES ------------------
Elec_ Service
Elec. Pedestal
Water Piping
Sewer
Gas Piping
BI E ME INSTALLATION - - - - - - - - - - - - - -
Support
Elec. Continuity
Wates Piping
Drainage
Gas Piping
DATE
REMARKS OR CORRECTIONS
(NOTE: An entry must be made on this form each time you visit the job site.)
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Oroville, California 95965
Telephone: 53.4-4541
APPLICATION AND PERMIT
authorize representatives of the County of Butte to enter upon the
above-mentioned op rty for inspection purposes.
a I -
X Date 4L /7 7
ignature Permitee or Agent
Receipt No. 6-001
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 UBLIC WORKS
By '0 --Date %2--5 -22--
B ding permit expires Date _ q—Z �- 7 E
BUILDING
Owner _
LL �
SQ. FT. OCC. BUILDING VALUATION
Mailing Address
Telephone No.
Fireplace
Contractor 44/«,d -- Z14 A46 -
Total Valuation 41Z
Mailing Address 173 —._ G
Permit Fee
Plan Checking Fee &/or Penalty
Telephone No.
Permit Fee � e, G
(�
Building Address
PLUMBING No. @ FEE
PERMIT FILING FEE $3'.00
"'Z 8 4 e-MEAC- ac
Each Trap 1.50 '
d
192 '71Water
Repair drainage or vent piping 1.50
piping 1.50
Each gas water heater or vent 1.50
A. P. Yo. — 1% —
Zoning & Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
s
��� 11
W,1C. o Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
Parking'Parcel
Plans Declaration
parcel Ma p
60' R/W
Im rovements
p
Lawn sprinkler system 2.00
Bldg. ahs Recd
cel Approval
pproval
Permit Fee $
$
NE ADDITION UTILITIES ❑ OTHER ❑
ELECTRICAL No.1 @ FEE
PERMIT FILING FEE $3.00
Main service 1100v OR LESS 5.00
100 AMP OR LESS
Main service EA. ADD'L 100 AMP 2.50
Single Family ® Duplex ❑ Mobil Home Others ❑
Main service OVER 600V100 AMP OR LESS 25.00
Main service EA. ADD•L 100 AMP 1.00
,�j ��/� /�
ffe 62(i /Xi
NEW CONST. DWELLING OCCUP. &
OR ACDNS. ACC. BLDGS. 2�Sq ft
NEW CONSTR. MULTI.OUTLET
NON-RESID. ( BRANCH CIRCUITS) 12.50ea
NEW CONSTR. (POWER APPARATUS &
NON RES D. SINGLE OUTLET CIR.
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:
N A4
Ex. Occup(OUTLETS OR FIXTURES) BAL@
FIXED APPLNS. OR
Ex. Occup.(OUTLETS (RESID.I EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. 7 Classification '6
Misc. Wiring 6.25
❑ I am exempt from the Contractors License Laws of the State of Califomia.
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 op rty for inspection purposes.
a I -
X Date 4L /7 7
ignature Permitee or Agent
Receipt No. 6-001
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 UBLIC WORKS
By '0 --Date %2--5 -22--
B ding permit expires Date _ q—Z �- 7 E
r ti
'036-350-049,- PERMIT#95-2335
_
: MILLET , Duard r
5289 Walmer'Rd., Oroville
Cont; George Roofing,'
'Reroof/SF "
r
y
i
c/4
Y
F
r
F
r
t
_r
COUNTY OF BU l- r = ue_PARTMENT OF DEVELOPMENT SERVICES - BUILDING'DIVISIO \
• 7 County Center Drive - Oroville, California -'95965 - Telephone (916) 538-7541 PERMIT -N'0'.
APPLICATION AND PERMIT
ASSESSOR PARC ~U
ZONING
BUILPING PERMIT
Ow ER
r I
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
3so O
CONTRACTOR'S NAME
r• co ,' < >< <
TELEPHONE
.5'7 3 •L 39,E
CONTRACTORS 0AIUNG ADDRESS //�� ����••,✓
�/ . i 4 //--9 /G'Ui rMe (z 7 WV
Fireplace
CONSTRUCTION LENDER
UNMOWN
Total Valuation $
LENDER'S MAILING ADDRESS
Filing Fee $ 20,00
Permit Fee $ ,00
43
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Ener Plan Checking Fee
Energy g $
Penalty $
•
BUILDING ADDRESStJO/ ..//N("
PERMITFEE S oo•
" t % r• ev «. ,- ,T„ �. , * tN*. �_ ,,
_ .: _, PLUMBING PERMIT - Filin_g Fee 20.00
Each Trap ` ' 7.00
LOTNO,
SUBgNISION'SNAME
ll
PARCEL MAP
Solar Or heat pump water heater 23.00
USEOFSTRUCTURE
w
SF' Duplex ❑"-Mobilehome MOther
/', 1.. 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: 66!fn l/ i i� /
Mobile Home S G W @20.00
PERMITFEE $
Contractor
ELECTRICAL PERMIT Filinq Fee 20.00
Main ServiceEOOV oR LESS
( zooA oR LEss ) 23.00
Main Service ( 200A TO 1000A ) 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 j�— '?,Q Lic. No. A&. V_6/(e
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that Ilam,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.
❑ 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. r _
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
NEW CONST. DWELLING OCCUP. s0.
OR AIJONS. ( 8 ACC. BLDS. ) 3.5¢ FT.
NEW CONST. MULTI -OUTLET
NON-RESID. ( BRANCH CIRCUITS ) 97.50
( POWER APPARATUS )
b SINGLE OUTLET CIR.
Ex. Occup. ( OUTLET OR FIXTURES) 20 @ 1.00
BAL .50
EX. Occup. OUTLEEDTS(RE Iso.)EA
( ) 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
r PERMITFEE. _ -
Contractor
WORKERS' COMPENSATION DECLARATION
I hereby apirm under penalty of perjury one of the following declarations:
❑ 1 hq a 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 by ers' compensation insurance carrier and policy number are:
Carrier _�%4'? i� �({JG{
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMITFEE $
Contractor
Policy Number �'_$'s C'� !�'
(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•thoseprovisions.
X _ /L fir*' �f- ,Datf�� 7�7, —
Signature of Applicant Owner ❑ CorStractor ❑ Agen
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 $
Energy Inspection Fee Is
OCC
CONST. TYPE
..
TOTAL FEE $ g ,
HA2.
-
D. FEES
IMP
FLOOD
CDF
PARCEL
PD HD
ISSUE
This permit is hereby issued under the applicable provisions
in the Butte County Code and/or beentp id to do work
indicated above for which fees have been aid.
BYE { / 1f ,� '- ' Date,.�_ C
PERMITEXPIRESON
(Dal) 1�
Receipt No. („ t •'
WHITE-D.D.S..-B�GCANXRY'-ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE- DEPARTMENT OFDEVoLOPMENTSERVICES-BUILDINGDIV ON
7 County Center Drive - Oroville,~California 95965 - Telephone (916) 538-7 1 3 ERM)vNO.
APPLICATION AND PERMIT
ASSESSOR PARC u
ZONING
BUI ING PERMIT
O ER (
U a r % e, •
TELEPHONE
. S/9S'
SO, FT. OCC. BUILDING VALUATION
,d'q 3foo,00
OWNER'S MAILING ADDRESS
a 9 g /11/0 41W eh 4ffzl,
CONTRACTOR'S NAME
e r o ��y
TELEPHONE
,x' 33 -G 3`T3
CONTRACTORS ILING
19-7,.T iduFireplace
CONSTRUCTION UENDJ&
UNMOWN
Total Valuation $
LENDER'S MAILING ADDRESS
Filing Fee
$ 20,00
Permit Fee
$ 61,00
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITkCT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS� n t //� 9251 j��
PERMITFEE $ 851 1`_!2_
PLUMBINGPERMIT
Filing Fee 20.00
Each Trap
7.00
LOT No.
SUBDIVISIONS NAME
PARCEL MAP
Solar Or heat pump water heater
23.00
USEOFSTRUCTURE
SF X 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 ❑ Unities ❑ Installation ❑ Other ❑
Describe Work: pf �li.��U-LG 62
Mobile Home I S I GI W 1
920.00
PERMITFEE
$
Contractor
ELECTRICAL PERMIT
Filina Fee 20:00
Main Service / 000V OR LESS
200A OR LESS )
23.00
Main Service ( 200A TO I000A )
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 C— 3q Lic. No. '7 S��tl�
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 OCCUR
oR ADDNS. ( a ACC. BUDS. )
So.
3.50 FT.
NEW CONST. MULTI -OUTLET
NON-RESID. ( BRANCH CIRCUITS )
97.50
( POWER APPARATUS )
8 SINGLE OUTLET CIR.
Ex. Occup. ( OUTLET OR FIXTURES)
20 @ 1.00
BAL .so
EXOccup. p. OUTELETS (RESID.) 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' co m.y �ensation insurance ^c�rrier and policy number are:
Carrier --Z-V et EU /i?
MECHANICAL PERMIT
Filing Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
PERMITFEE
$
Contractor
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
forth * h comp y with those rovisio
r
X _ _ _ Dater/
Signature of Applicant - Owner ❑ tractor Agenof
An OSHA permit is requi ed for excavations over 5'0" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee Is
OCC
CONST. TYPE
I
TOTAL FEE $ g 3,
HA2.
I D. FEES
I IMP
I FLOOD
J_77_[ -P7
PD HD
ISSUE
This permit is hereby issued under the
of the Butte County Code and/or
indicated above for which fees have
ByMidd-
applicable provisions
Resolutions to do work
been paid.
Date o2� 49
fpm
ReceiptNo.PERMITEXPIRESON
WHITE-D.D.S.-B.D. CANA Y- SSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT