HomeMy WebLinkAbout078-220-0550
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LYLE DANIELS J1 / % ��77 t- 'Z�10
12 Rosita Way, Oroville
•--ontr: A-1 Masonary Co-ntr.,Oro.-
Permit ##5536-75B(remove & replace 17
complete fireplace -EQ Damage/SF)
Contr:George Roofing
Permit#1561-85B(reroof/SF)
��� ccn ncc 05-1573
CLEMONS, ERNEST
12-ROSITA WY, OROVILLE .
Cont: OWNER
RE -ROOF 4��
0
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NOTES
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RESIDENTIAL
PERMIT NQ -
036 -550-055
_
036-550-055 05-1573
CLEMONS, ERNEST
+ 12 ROSITA WY, OROVILLE
I Cont: OWNER
RE -ROOF
I
B
SPECIAL CONDITIONS
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
JOB FINALED (Date) F v�
Signature �� !�
CHECKED
BY
JaOK
0- Not OK
. = NotRy ble
. =Not Ready
MOBILE HOMES
Date
MOBILE HOME UTILITIES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support Sketch
3. Sewer, Location -Test -Fall -C/O -Concrete
4. Water; Location -Test -Easement Needed (Sketch)
5. Electricity, Location-Clearances-Gmd-/ /Amp -Concrete
6. Gas; Location -Test -Wrap;-/ /" L'ft.
/ P Nat. or/ /" L "ft! P LPG
7. Well Clearance S Disconnect
8. Utility Clearance
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date MOBILE HOME INSTALLATION (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
3. Gas; MH Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
5. Drain; MH Test -Fall -Flex Connector
6. Water, MH Test-Regulator-Connectoe
7. Water and Sewer Connected -C/O to Grade -HD Approval
8. Gas and Electricity Tagged
9. Tie Downs -Type -Installation Cert.
10. Exits; Insp.-Sketch
11. Cert. of Occupancy
Date Cana B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date PERMANENT END SYSTEM (ONLY)
1. Zoning Requirements -Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
3. Blocking
4. Gas; MH Test -Demand -Valve
5. Electricity; MH Test
6. Water, MH Test
7. Water and Sewer Connected
8. Gas and Electricity Tagged
9. Exits
10. License Decals
11. Verify #'s with Office
Date Card B-1 Date Card B-1
Date - Card B-1 Date Cana B-1
MISCELLANEOUS
Date DECKS, COVERS, CARPORTS, GARAGES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3. Decks, Girders and/or Joists -Decking -Bracing -Stairs -Rails
4. Wood Awn.; Posts-Beams-Rftrs-Connectors
Shthg-Frg-Bracing
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Carports; Windows -Doors
T. Electric
8. Frmg.; Sills-Anchors-Studs-Rftrs-Trusses
9. Siding; Nailing -Veneer -Stucco -Mesh
10. Roof; Shthg-Roofing
11. Ext.; Steps -Doors -Landings
12. Braced Wall Panels
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date POOLS (Plans) OK except #'s
1. Setbacks -Easements
2. Soils; Compaction -Structure Stability
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4. Elec.; Receptacles and Lighting, Distance-GFI
5. Elec.; Pool Lighting; 15 Volts-GFI
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8. -Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes-Enclosures-Panelboards-Ins. to Main Conduit
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
11. Light Niche
12. Enclosure; Fencing -Alarms
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
J=OK
0 = NotOK
Applicable =Not Aplicable RESIDENiIAL (Single & Duplex)
•
= Not Ready
Date UNDERFLOOR (Plans) OK except #'s
1. Zoning -Setbacks -Easements -Flood -Slope
2. Ftg., Main; Soils-Elec. Gmd.-/ r Ftg. Depth
3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ P' Ftg. Depth
4. Ftg., Porches & Decks; Soils -Steel-/ /' Ftg. Depth
5. Stemwalls, Main; Steel-Blockouts-Wrapped
6. Stemwalls, Garage; Steel-Blockouts-Wrapped
6a. Hold Downs and Special Anchors
7. Slab, Steel -Wrapped
8. Piers -Fireplace Ftg.-Steel
9. D.W.V; Fall -Fitting -Test -2 Way C/O -Sewer Test
10. UF, Gas Pipe; Size Anchors -Yard Gas Piping; Size Test
11. Water Pipe; Test -Anchors -Regulator -Service Test
12. Electric Underground
13. Plenums & Ducts; Clearance -Material -Support -Ins.
14. Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
15. Access & Ventilation
16. Insulation
42. Walls Studs -Nailing Spacing & Braces -Plates -Sound
43. Bearing Walls over Girders & Floor Nailing
44, Draft Stop in Walls (rat proof)
45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
46. Headers & Beams -Size & Bearing
Date FRAMING (Continued)
47. Hangers -Post Caps -Anchors -Connectors
48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac: Truss-Shting.-Rtng.
49. Fireplace Ties or Type AFlue-Fireplace Throat Clearance
50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
51. Bdrm. Windows or Exiting Doors -Sill Ht & Dimensions
52. Garage Fire Protection Framing -RC Channel
53. Property Line Firewall & Openings
54. Ext. Doors -One T -Check Garage 3rd Story, 2 Exits
55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
57. Siding -Nailing Veneer
58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
59. Glazing Area -Glass Protection -Skylights -Plastic
60. Shear Walls; Nailing -Bolts
61. Brace Interior/Exterior Wall Panels
62.Insulation-Walls-Ceilings
63. Infiltration -Walls -Windows
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date FINAL (Plans) OK except #'s
64. Ext. Steps -Door & Sidelight Protection -Landings
65. Smoke Detector
66. Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
67. Bedroom Exiting
68. G.F.I. & Bath Fixtures & Tub Access -Spa
69. Elec. Trim & Suboanel. Breaker Sizes & Labels
70. Stairs & Rails
71. Fireplace or Stove, Clearance -Hearth
72. Elec. Outlets at Wood Panel, Int. & Ext.
73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance
74. Elec. Outlets & Receptacles at Kit. Counter
75. Garage Fire Door, Swing -Landing -Closure
76. A.C. Dud in Garage -Damper
77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
78. Plb.; Elec. & Mech. Equip. Listed for Location
79. Elec. Receptacles in Garage (F.F.I.)-Romex Protection
80. Insulation -Foam -Looked in Attic
81. Guard Rails & Deck Construction -Post Caps
82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor O Yes
83. Following InstldJDrive O Yes O No/Walks O Yes O No/Planters O Yes O No
84. Stucco Brown -Finish
85. A.C. Unit Disconnect, Electrical -Plumbing
86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
87. Water Well, Disconnect, Electrical, Plumbing
88. Exterior Elec. Trim, G.F.I. Receptacle -Underground
89. Ventilation Throughout House
90. Glass Protection
91. Corrections from Previous Inspections
92. Gas Test -Meters Tagged, Gas -Electric
93. Water & Sewer Connected -C/O to Grade -HD Approval
94. Energy Compliance Certificate -Other Certificates
95. Address Posted
96. Fire Sprinkler
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Comments at Final:
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
PLUMBING (Permit) OK except #'s
17. Water Htr.; Vent -Access -Combustion Air Baffle
18. Water Pipe; Test & Anchor -Nail Protection
19. D.W.V.; Test Fittings & Anchor -Nail Protection
20. Shower Pan; Test, First Floor -Tub Access
21. Test Tub & Shower, Second Floor -Tub Access
22. Gas Pipe; Sixe & Anchors
23. Fire Sprinkler, Test
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
ELECTRICAL (Permit) OK except #'s
24. Fixture & Transformer Clearance -Ins. Protection
25. Elec. Receptacles Spacing -Lights & Switches at Doors
26. Size Boxes & No. of Conductors Stapled
27. Romex Installed Close to Edge of Studs & C.J.
28. Equip. Ground made up w/Meth Fasteners -Bond Gas & Water
29. 2 Appliance Circuits in Kitchen & Conductor Size GFI
30. Subfeed Wire Size/ /ga. Cu or AI -AC. Wire Size/ /ga Cu or AI
31. Range Circle/ /ga Cu or AI -Oven Circ. / /ga Cu or AI
Insulated Neutral O Yes O No
32. Service -Riser Conductors & Ground Main Disconnect
33. Equip. Clearances Panels -Motors -Meth. Equip.
34. Clothes Closet Light -Shower Light -Spa Light
35. Smoke Detector
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MECHANICAL (Permit) OK except #'s
36. A.C. Ducts Insulation & Support
37. Vent Fan, Exhaust above insulation
38. Condensate Drain & Overflow, Size & Grade
39. Fumace-Vent Access -Comb. Ait-Return Air Vent 115 Outlet
40. Attic Access & Platform if Furnace in Attic
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
FRAMING (Permit) OK except #'s
41. Sills Proper Materials & Anchors
42. Walls Studs -Nailing Spacing & Braces -Plates -Sound
43. Bearing Walls over Girders & Floor Nailing
44, Draft Stop in Walls (rat proof)
45. Fire Stops, Furred Ceilings -Stairs -Chasers -Tubs
46. Headers & Beams -Size & Bearing
Date FRAMING (Continued)
47. Hangers -Post Caps -Anchors -Connectors
48. Cling. Joist-Rftr. Ties-Purlin-Roll Brac: Truss-Shting.-Rtng.
49. Fireplace Ties or Type AFlue-Fireplace Throat Clearance
50. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
51. Bdrm. Windows or Exiting Doors -Sill Ht & Dimensions
52. Garage Fire Protection Framing -RC Channel
53. Property Line Firewall & Openings
54. Ext. Doors -One T -Check Garage 3rd Story, 2 Exits
55. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
56. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
57. Siding -Nailing Veneer
58. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
59. Glazing Area -Glass Protection -Skylights -Plastic
60. Shear Walls; Nailing -Bolts
61. Brace Interior/Exterior Wall Panels
62.Insulation-Walls-Ceilings
63. Infiltration -Walls -Windows
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date FINAL (Plans) OK except #'s
64. Ext. Steps -Door & Sidelight Protection -Landings
65. Smoke Detector
66. Furnace Vents -clearance -Comb, Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
67. Bedroom Exiting
68. G.F.I. & Bath Fixtures & Tub Access -Spa
69. Elec. Trim & Suboanel. Breaker Sizes & Labels
70. Stairs & Rails
71. Fireplace or Stove, Clearance -Hearth
72. Elec. Outlets at Wood Panel, Int. & Ext.
73. Kit. Fixt. & Appliance; Ground -Air -Gap -Cooking Clearance
74. Elec. Outlets & Receptacles at Kit. Counter
75. Garage Fire Door, Swing -Landing -Closure
76. A.C. Dud in Garage -Damper
77. Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above Floor-Mech. Protection
78. Plb.; Elec. & Mech. Equip. Listed for Location
79. Elec. Receptacles in Garage (F.F.I.)-Romex Protection
80. Insulation -Foam -Looked in Attic
81. Guard Rails & Deck Construction -Post Caps
82. Fdn. VBents & Crawl Hole Door Drainage & Wood -Earth
Clearance Looked under Floor O Yes
83. Following InstldJDrive O Yes O No/Walks O Yes O No/Planters O Yes O No
84. Stucco Brown -Finish
85. A.C. Unit Disconnect, Electrical -Plumbing
86. Vents Above Roof, Plbg-Appliance-Fireplace-Clearance to Openings
87. Water Well, Disconnect, Electrical, Plumbing
88. Exterior Elec. Trim, G.F.I. Receptacle -Underground
89. Ventilation Throughout House
90. Glass Protection
91. Corrections from Previous Inspections
92. Gas Test -Meters Tagged, Gas -Electric
93. Water & Sewer Connected -C/O to Grade -HD Approval
94. Energy Compliance Certificate -Other Certificates
95. Address Posted
96. Fire Sprinkler
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Comments at Final:
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAX#: (530)538-2140
WEBSITE: www.buttecounty.net\dds
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
the Business and Professions Code, and my license is in full force and
effect.
License Class: License Number:
Date: Contractor.
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
permit to construct, alter, improve, demolish, or repair any structure, prior,
to its issuarice;-also requires the applicant for such permit to file a``
signed statement that'he or she is licensed pursuant to the.provisions of
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
she i5 exempt therefromand the basis for the alleged exemption. Any
violation. of -Section 7031.5 by any applicant fora permit subjects the
aapp�licanf:to a civil penalty of not more than five hundred dollars ($500).):.
IQ 1. as- 6wner-of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
intended,oroffered for sale (5ec,.7044,. Business and.Frofessions_
Code: The Contractors' State License Law does not apply to an
owner of property who builds or improves thereon, and. who does
suchworkhimself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale: If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
proving that he or she did not build or improve for the purpose of
sale.).
❑ . _„1— 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
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.).
D 1 am Exempt under Article 3 f the Business and Professions Code
Date: 1 E' , Owner:
WORKERS' COMPENSATION DECLARATION
I hereby.affinm under penalty of perjury one of the following declarations:
(31 have and will maintain a certificate of consent to self -insure for
workers'-comoensation,.•as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit
is issued.
❑ l 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:
Carrier:
Policy #:
v 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,
and agree that - if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall
forthwwithccoLmply with those provisions.
Date:
n _ r -
Applicant: i o�-✓`�
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code„interest, and attorney's fees,
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec 3097 Civ.)
PERMIT NO.
BP051573
Issued Date: 06/16/2005 APN: 036-550-055-000 .
Site Address: 12 ROSITA WAY ORO
Map Index:
Description: reroof w/ 3.0 yr comp (20)
Owner: CLEMONS ERNEST
12 ROSITA WAY -
_ ' t'
OROVILLE,-CA.
95966-6937
_... App.licant:,,CLEMON.S ERNEST..._ .,..._. _.._ ti ..
12 ROSITA WAY
OROVILLE, CA
95966-6937
Contractor:
License #:
Architect:
_
-Engineer:
Total Square Ft: 0 S. F.
Valuation: $0.00
Census Code:
This permit is hereby issued under the
Resolutioris-to,tillo-w0rk indicated above
licable provisions of the Butte Cnunty Code anrVor
which fees have been paid.
) r , Datte: 1�
Address: I PERMIT EXPIRES' L2, • 6 �P
(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 representatives of Butte County to enter upon the above mentioned property for inspection
• purposes.
Print Name: P/V%5 i �y .i X // �• (U �C _ c
'
Signature: ter
Date: (� d
❑ Contractor
❑ Agent for Owner
D Agent for Contractor
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 OFAPPLICA TION
Website: www.buttecounty.net/dds
*PLEASE PRINT CLEARLY**
ARCHITECT/ENGINEER
OWNER
Last Name
Y19j_/
First Name �Q
Address
o
City
Stat
Zip C�sq
Phone �,�
� gv
Fax
E-mail
Planner
ARCHITECT/ENGINEER
CONTRACTOR
Name
Y19j_/
Address
Zip
City
Fax
State
Zip
Phone
Map Book
Fax
E-mail
Planner
Lic. #
Class
ARCHITECT/ENGINEER
Name
Address
City
State
Zip
Phone
Fax
E-mail
State License Number
APPLICANT NAME
Name
Address
City
State
Zip
Phone
Fax
E-mail
APPLICANT SIGNATURE
X
For office use only:
Zoning
Property Ad
d Q_
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
G'5. ?)
BP
BIN #
LOCATION
AP# 055
Property Ad
d Q_
Cit
tvo
Cross Street
SRA
WORKER'S COMPENSATION
Policy Number
Carrier
1f 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
Description or Scope of Work:
Sq. Footage
❑ 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
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.
Page 1 of 2
REV 2-24-05
d by: Amount:
V
` O ~_ Bldg
SRA
Receipt #:
Sheriff
' \
4 � ( l*
SMIP
Date: � L
;;-Other
Total
Total
Page 1 of 2
REV 2-24-05
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.
❑ 5. Statement of Intent for Non -heated and A/C for Non -Residential Buildings.
❑ 6. Manufactured homes: (A) 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).
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). -
0
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.
❑
12.
Sanitation and site plan approval from the Environmental Health Department.
If you have questions or would like additional information regarding this process, please contact a
Permit 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
KAFORMSWILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 2-24-05
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISI0(1I
7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140
PERMIT APPLICATION DATA SHEET
OWNER: ASSESSOR PARCEL NUMBER
c��1P SSo •USS
Proposed Building Use: (��� Permit Technician: Date:
Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in orde pply.
O 1. Site plans, 3 or 4 sets, signed by the preparer of the plans.' .
❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans.
❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
❑ 4. Engineered truss details and layouts in duplicate. No faxesl
❑ 5. Letter from Engineer or Architect for truss design review.
❑ 6. Energy compliance design and supporting documentation in duplicate.
❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings.
❑ 8. Manufactured homes: (A) Installation manual, including marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in
duplicate.
❑ 9. 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.
❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate.
❑ 11. Letter of intent fog non-residential buildings.
❑ 12. Hazardous Material Form
❑ 13. Acknowledgement of building permit application without required clearances.
❑ 14. Other
Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.)
❑ 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable
❑ 16. Fire Sprinkler%............................................................ I..............................
❑ 17. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by
❑ 18. Soils Report and/or Engineered Foundation required ...........................................
❑ 19. Erosion Control Plan Required........................................................................
❑ 20. Fees as shown on the attached Schedule of Fees Due Sheet ..............................
❑ 21. City of Chico Plumbing permit........................................................................
❑ 22. Site plan and business license approval from the City of Biggs ..............................
❑ 23. California Department of Forestry plan approval ❑ paid. Sent by: .............
❑ 24. Planning approval for (A) Use: (B)Parking: (C) Parcel Check: . * ... ....
heck:............
❑ 25. Contact Land Development about _ Improvements, _ Drainage ........................
❑ 26. NPDES Form.....................................................................:.......................
❑ 27. Encroachment Permit for driveway from the Public Works Dept ...........................
❑ 28. Contractor's license information. (Number, Name Style, Classification) ...................
❑ 29. Worker's Compensation Carrier and Policy Number ..........................................
30. Owner -Builder Verification (_ Given to owner, _Mailed to owner) .....................
❑ 31. Letter of Signature authorization....................................................................
❑ 32. Recorded copy of Agricultural Acknowledgment Statement .................................
❑ 33. Existing violations and/or expired permits...............................,........................
.
❑ 34. Deed Restriction .................................. ........................::..............................
❑ 35. ❑ Legal description, ❑ M.H. Title, title search, registration or MCO .........................
❑ 36. Other:
❑ 37. Other:
When issued Telephone o and hold for pickup.
I have been infor ed of the above items and requirements for obtaining a building permit.
Applicant: 6/GAGS
-�'`� Date:
1. Index permit application for the above items numbered:// Plan Check Letter
2. Additional items required
Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date:
Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date:
Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date:
Plans reviewed by: Date: Plans approved by: Date:
Structural reviewed by: Date: Structural approved by: Date:
Note transfer by: Date:
Yellow: Building Division
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing your
signature.
Please complete and return this information at your earliest opportunity to avoid unnecessary
delay in processing and issuing your building permit. No building permit will be issued until this
verification is,received.
I personally plan to provide the major labor and material for construction of this proposed
property improvement: YES [ ] NO [ ].
I HAVE [X ] HAVE NOT [ ] signed an application for a building permit for the proposed
work.
3. I have contracted with the following person (firm) to provide the proposed construction:
NAME: _
ADDRESS:
PHONE:
CONTRACTOR'S LICENSE NO:
4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise, and provide the major work:
NAME: _
ADDRESS:
PHONE:
CONTRACTOR'S LICENSE NO:
5. I will provide some of the work but I have contracted (hired) the following persons to provide
the work indicated:
NAME ADDRESS PHONE TYPE OF WORK
�NED:
PROPERTY OWNER:
DATE: 6 ^ 16 — cs
NOTE: This Owner -Builder verification is required by Section 19831 and 19832 of the California
Health and Safety Code.
This verification must be completed and returned to our office before -we are permitted to issue the
permit.
Rev'd 11/4/2004
Butte County Department of Development Services
ADMINISTRATION `BUILDING `GIS' PLANNING
7 County Center Drive
Oroville, CA 95965
(530) 538.7541 Telephone
(530) 538-2140 Facsimile
�o!i�'vi�.»�?i.�'�.�"� u� �oiciz^•ck mi2+} x F,ta �'r"�. *.4` F.. du"iK;C tiC� rt.G � 'k 37.,y'ti;'n'}4,i-iY ;E° � .rS.T,�
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their own
work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if
that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the city or county. They are also required by law to put their license number on all permits for which they apply.
If you plan to do your own work, with the exception of various trades that your plan to subcontract, you should be
aware of the following information for your benefit and protection:
o If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200 or more for the entire project and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
o If you are an employer, you must register with the state and federal government as an employer and you are subject
to several obligations including state and federal income tax withholding, federal social security taxes, workers'
compensation insurance, disability insurance costs, and unemployment compensation contributions.
o There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious
with respect to workers' compensation insurance.
o For more specific information about your obligations under federal law, contact the Internal Revenue Service (and,
if you wish, the U.S. Small Business Administration). For more specific information about your obligations under
state law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "owner -builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building
permits are not required to be signed by property owners unless they are performing their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification from so that we can confirm that you are aware
of these matters. The building permit will not be issued until the verification is returned.
MicVael C. Vieiri C.B.O.
Ma ager, Building Inspection
NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.
Permit#1561-85D o
Lyle Daniels
12 Booita gay, Oro
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION AND PERMIT }
ASSESSOR —ARCEL NUMBER
,PjS 55
ZONING
BUILDING PERMIT
OWNER
Lyle Daniels 312-
TELEPHONE
376-1683
SQ. FT. OCC.1 BUILDING VALUATION
l)l 11OWNER'S
MAILING ADDRESS
4338 South Karlav Chicago, Ill. 60632
CONTRACTOR'S NAME
Georg RDofin
TELEPHONE
533-6393
CONTRACTOR'S MAILING ADDRESS
3923 Olive• Oroville
CONSTRUCTION LENDER
UNKNOWN
Fireplace
Total Valuation $ lie".
LENDER'S MAILING ADDRESS
Permit Fee I $
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee Is int I
Penalty $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee $ , /1j
BUILDING ADDRESS
12 Amita My orovill,e
PLUMBING PERMIT Filing Fee 3.00
Each Trap 2.00
Repair drainage or vent piping 2.00
-----•�— f - ...,.,:... _ ,.. ..�._ :s..- ax: =--_"_ ."�^-s
;-Water=piping-,.
LOT NO.
SUBDIVISION NAME
PARCELTMAP
Each qas water heater or vent 2.00
Gas piping system 1 - 5 outlets
qy ; USE OF STRUCTURE
SF ® Duplex❑ Mobil'ehome❑ Other
SPECIFY
Building sewer
Lawn sprinkler system 2.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Uti lities ❑ InstallationF_ Other 12
Describe work: RDo6iafa
Permit Fee $
Contractor '
ELECTRICAL PERMIT Filing Fee 3.00
Main service 600V OR LESS
100 AMP OR LESS 5.00
Main service EA. ADD'L 100 AMP 2.50
NEW CONST. ( DWELING
OR ADONS. ACCLBLDGS.CCUP,&) 20sgft
CONTRACTORS LICENSE LAWNEW
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
❑ 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
CONSTR ULTI.OUTLET 2,50 ea
NON-RESID. BRANCH CIRC ITS
NEW CONSTR. /POWER APPARATUS a
NON.RESID, SINGLE OUTLET CIR.
EX. OCCUp(OUTLETS OR FIXTURES BAL@1
ALos
FIXED APPLES. OR
Ex. Occu /OUTLETS (RESID.) EA.) 2.00
p•\
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 6.25
Permit Fee $
Contractor
MECHANICAL PERMIT FiIingFee 3.00
WORKMEN'S COMPENSATION INSURANCE,
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑j 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.
Heating
Cooling
Hood 2.00
Ventilation
permit Fee $
Contractor
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 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 said County in consequence of the granting of this permit.
X Date N$V a ]�$�
Signature of Applicant — Owner 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 $
Land Development Fee $
TOTAL PERMIT FEE $ S
OCCUR. GROUP
I TYPE OF CONST.
PARCEL
PD
HD
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.
/,--/DIRECTOR OF PUBLIC WORKS
By / i 1 r vl .. ll.' !,t' L Date ? /�?/ i/X
—T•
PERMIT EXPIRES/Date— f•/` yYyy�...//``
/'/!)f^
r r'�
Receipt No. �+
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD-APPL I CANT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION AND PERMIT
PERMIT No.
ASSESSORPARCE NUMBE
—�`j —�"
ZONING
BUILDING PERMIT
OWNER
Lyle Daniels 312-
TELEPHONE
376-1683
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
4338 South Karlov Chicago, Ill. 60632
CONTRACTOR'S NAME
George Fbofin
TELEPHONE
533-6393
CONTRACTOR'S MAILING ADDRESS
3923 Olive Hwy. Oroville
CONSTRUCTION LENDER UNKNOWN
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
1O1 D
Permit Fee
$
ARCHITECT OR ENGINEER LICENSE NO.
Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
Permit fee
$
BUILDING ADDRESS
12 Rosita WayOroville
PLUMBING PERMIT
Filing Fee 3.00
Each Trap
2.00
Repair drainage or vent piping
2.00
Water piping
LOT NO.SUBDIVISION NAME PARCEL MAP
Each qas water heater or vent
2.00
Gas piping system 1 - 5 outlets
USE OF STRUCTURE
Building sewer
Lawn sprinkler system
2.00
SF [2t Duplex ❑ Mobi lehome ❑ Other
SPECIFY
TYPE OF WORK
Permit Fee
$
New ❑ Addition ❑ Remodel ❑ Utilities ❑ InstallationEl Other El
Contractor
ELECTRICAL PERMIT
Filing Fee 3.00
Describe work: Roofing
Main service 100 AMP ORV OR LESS5.00
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. DWELLING OCCUR.&
OR ADDNS. ACC. BLDGS.
20sgft
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
NEW CONSTNON-RESID R BRANCH CTRCTITS 2.50 ea
NEw CONSTR. (POWER APPARATUS a
NON-RESID. (SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES 50@�
BAL@10C
FIXED APPLNS. OR Ex. OCcu
p•(DUTLETS (RESID.) EA.) 2.00
Temporary service
10.00
❑ I, as the owner, or my employees with wages as their sole compen-
Mobile Home Facilities
15.00
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)
Misc. Wiring
6.25
Permit Fee
$
❑ I am exempt under Sec. , Business and Professions Code
Contractor
for this reason
WORKMEN'S COMPENSATION INSURANCE
MECHANICAL PERMIT
FiIingFee 3.00
Heating
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.
Cooling
Hood
2.00
Ventilation
❑ 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.
permit Fee
$
Contractor
I certify that I have read this application and state that the above information
Mobile Home Installation Fee
$
Land Development Fee
$
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.
TOTAL PERMIT FEE
'5y"
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
occUP, GROUP
I TYPE OF CONST.
PARCEL
PD
I ND
I ISSUE
against said ounty in consequence of the granting of this permit.
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.
X ,� l Date May 28 1, 1985
Signature of Applicant — Owner ❑ Contractor ❑ Agent 1I
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of Structures ovv+eer33 stories in height.
/2IRECTO F P BLIC
By _
PERMIT EXPIRES Date
WORKS
ate 11
D
Receipt No. ��5 V7i tY-�
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
PERMIT NO. 5536-75B
P
W
1'. E
M
MH UTIL.
PERMIT NO.
PERMIT EXPIRES ,/ dzal,�L,���
OWNER Lyle Daniels
CONTR. A-1 Masonary, Oroville
LOCATION (A.P. 36-55-55
12 Rosita Way, Oro Me
e
i
i
t
e
A
r
Temp. Power Pole
Called PG&E
Temp. Elea Serv.
Called PG&E
Temp. Gas Serv.
Called PG&E
JOB
FINALED
(Date)
_������
(Signature)
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION RECORD
BUILDING
BUIL IN G (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
I Water Piping
Piers
Roofing
Sewer
Garage
Fdn. Vents v
Fixtures
Footings
Garage Vents A
Water Htr.
Stemwall
Slab
Prov. for physically /
handicapped
Heaters
Appliances
Carport
Footings
Conformance of ex.
structure
Gas Piping &Test
Temp. Gas
Slab v
Final
Sanitation
Patio A
FI EPLACE
Final
Footings
Footing
ELEC
RICAL
Masonry Walls
Throat
Rough A
Reinf. Steel
Final %
Fixtures
Bond Beam
FIRE,SPRINKLERS,
Motors
Framing
Test
Water Htr.
Stucco
Final
Subpanels
Mesh
MEC NI L
Grd. Fault Prot.
Scratch
Heating
Service
Brown
Cooling
Temp. Pole
Finish
Ducts
Underground
Interior Lath
Ventilation
Permanent
Door Closer
Final
Final
DATE REMARKS OR CORRECTIONS
COUNTY OF BUTTE — DEPAP�TIVIENaT OF PUBLIC WORKS ;t. _ 7,5'
7 County Center Drive — broville, California 95965
- Telephone: 534-4541 /
APPLICATION AND PERMIT
-^ •.r•. ..- — ..-y v uu ,U cn,cI uNvn uic
above- entioned pro erty f r inspection purposes.
Signature of Per a or Agent
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 O�BLIC WORKS
BY Date
(ding permit expires Date >(a
BUILDING
Owner
SQ. FT. OCC. BUILDING VALUATION
Mai I i ng Ad ss
Telephone No.
Fireplace U
Contractor
Total Valuation
Mailing Address
Permit Fee
P I an Checking Fee &/or Penalty
Telephon
� �_ �/6
Permit Fee
Building Address
PLUMBING No.1 @ I FEE
PERMIT FILING FEE J$3.00
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. J (_S ��r
J l�
Zoning 8 Planning
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
9"&-
Sarii4a4+en
Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
Parking
Plans
Parcel
Declaration
Parcel Ma P
60' R/W
Im rovements
P
Lawn sprinkler system 2.00
Parcel Approval
Plans Approval
Permit Fee $
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER �,
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
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 b �alfa2
Recaps., switches & fix outlets Ei—i Jnl
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- �—
h
Hood, Ex. Fan or F.A. Furn. Motor 1.00
Evap. cooler, gar. disp. or D.W. 1.00
Air conditioner or heat pump
Water pump
Mobil Home Facilities 5.00
Temp. Power Pole 5.00
License No.�/j LD 'f Classification
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
6en'sfor Wor Compensation.
ave 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.1 @ FEEPERMIT
FILING FEE J$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
-^ •.r•. ..- — ..-y v uu ,U cn,cI uNvn uic
above- entioned pro erty f r inspection purposes.
Signature of Per a or Agent
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 O�BLIC WORKS
BY Date
(ding permit expires Date >(a
Aly
cw.
Diane
REQUEST FOR EARTHQUAKY, INSPECTION
Date /,.Oz/-
V.
,.O�/-S�
(last name) (f rst name)
Address- / 2 PO S i-747 Y DSD Ui c Lc"
Directions
ITLMS OF CONICERl`1:
(/2ts�C.i� Cid
Telephone
-------------=------_--_---- -'INSPECTION
Date
==-==(' ��,i'` 2U
NATURE OF DAMAGE:
/O /-1/7 6—
Danger:
moo-
Action:
Inspector