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HomeMy WebLinkAbout078-230-044e ..� WYNOKA HOMES ,�%!�°���1//>j"' 537.7 Cre stridge Dr., Or6vi11e Permit# 813-75B ( new SF) CC4:r /0'6 CONTR: Gridley Plbg.�Q�9�y�� f--- Permit#-2115-75P(for 813-75 ONTR: Huggitt Lighting & Elec. Permit :W2482 -75E (elec. for permit #813-75) T/il9�'o,�/�%lam CONTR: Sweem's AC, Oroville I Ww l Permit# 3071-75M(f or 813-75) f 0 J I r �t I t i ..� WYNOKA HOMES ,�%!�°���1//>j"' 537.7 Cre stridge Dr., Or6vi11e Permit# 813-75B ( new SF) CC4:r /0'6 CONTR: Gridley Plbg.�Q�9�y�� f--- Permit#-2115-75P(for 813-75 ONTR: Huggitt Lighting & Elec. Permit :W2482 -75E (elec. for permit #813-75) T/il9�'o,�/�%lam CONTR: Sweem's AC, Oroville I Ww l Permit# 3071-75M(f or 813-75) f 0 J I r �t I t 0 BUTTE COUNTY BUILDING OFFICIALSL •JURISDICTION Block Parcel No. Detailed Evaluation Safety Assessment Form BUII.DING D �CON: WIV � � � Name: Address: 7 7 C kf. 12) 06 E No. of Stories: t Basement: Yes ❑ No-SkUnknown ❑ Approximate Age: _ Years Approximate Area: Square feet Structural Sstem: X6,46 Wood Framek- Unreinforced Masonry ❑ Reinforced Masonry ❑ Tilt -up ❑ Concrete Frame ❑ Concrete Shear Wall ❑ ' Steel Frame ❑ Other _ Primary Occupancy: Dwelling Other Residential [I Commercial ❑ Office ❑ ndustrial ❑ Public Assembly ❑ School ❑ Government ❑ Emer. Serv..❑ Historic ❑ Other _ OVERALL RATING: (Check One) INSPECTED (Green) LIMITED ENTRY (Yellow) ❑ UNSAFE (Red) INSPECTOR Inspector ID Affiliation ■0 INSPECTION DA Mo/day/year ! /z 15" Time 31,119 am ®m /f y2k : 3: 0 ?-, PA,�- g/GL 6,491C0/l1 Instructions: Complete building evaluation and checklist on next page and then summarize results below. Posting: Existing Recommended None 11 ,Assessment at this ssessment Inspected (Green) ❑ [I Yes No Limited Entry (Yellow) ❑ ❑ Existing posting by: Unsafe (Red) ❑ ❑ Recommendations: No further action required ❑ Engineering Evaluation required (circle one). Structural Geotechnical Other ❑ Barricades needed in the following areas: ❑ Other (falling hazard removal, shoring/bracing required, etc.): Comments (Why posted Unsafe Sheet / of Detcdled Evaluation Safety Assessment Form (COXInued) Instructions: Examine the building to determine if any hazardou/If xis -L A "yes" answer in categories 1, 2, or 4 is grounds for posting building UNSition is suspected to be unsafe acid snore review is needed, check appropriate Unknoand post LITM IED ENTRY. A "yes" answer in category 3 requires posting and/or bardicate AREA UNSAFE. Explain "Yes", "Unknown" findings and extent of damagmments." Hazardous Csts Condition Yes No Unknown lComments 1. Structure Hazardous Overall Collapse/partial collapse ❑ ❑ ❑ __ Building or story leaning ❑ ❑ Other ❑ ❑ 2. Hazardous Structural Elements Foundations - ❑ ❑ Roof/floors (vertical loads) ❑ Columns/pilasters/corbels ❑ Diaphragms/horizontal bracing ❑ ❑ Walls/vertical-bracing Moment frames (� Precast connections ❑ ❑ OtherEl ❑ 3. Nonstructural Hazards Parapets/ornamentation Cladding/glazing Ceilings/light fixtures Interior walls/partitions Elevators Stairs/exits Electric/gas Other 4. Geotechnical Ha ands Slope failure/ ebris . Ground mo ment. fissures ❑' ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑' ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ZS�rC . . . . . . . . . . . . . . . . . . . . . . . .. ........... Sheet -- of—n a I DATE 1-,12-!Zq TIME11--48 ESTIMATED DAMAGEi2w- -M BY /_7ZJd 11 -- DAMAGE REPORT FOR INITIAL ASSESSMENT FLOOD JANUARY 1995 PUBLIC INFORMATION OFFICER 538-6953 Name Reporting Party E CF -A//3 a PEz Address/Location S37?2C f2!sjr� iLaT-- �G Telephone Number S 33- 9'5.3 City f County Type of Damage 140L4S;; 6-664 FJ (Note: Emergencies Refer to 911) Building Description [ ] Commercial/Usage [ �] Residential Type and # Units [ ✓f Currently Occupied/Use [ ] Abandoned/Vacant Electric Any electrical submerged Yes [ ] No [ V' - Obvious Obvious damage (failure, downed wires, arcing) Gas Natural/Propane NIA Obvious problems (odor, leaks, leaks, propane tank floating/submerged) On[ ] Off[ ] Structure n Off Foundation loodin above below floor `/ Obvious leaning, tilting _ /T/A Severe Damage/Collapse _ /A - Debris Hazard Sanitation Plumbing working Running water 0 1< Well Flooded .. 1 Obvious Sewage Problems alb Chemical/Fuel Wet, flooded, lost chemicals Type pesticide, fertilizer, other chemicals Amount . Fuel tanks (above or below ground) Obvious hazards Agriculture Loss Crop Damage Livestock Lost Building Damage Roads (Public) Road Name Obvious Damage/Hazards Location/Landmarks Traversable (Sedan, 4 wheel) Involved Utilities (downed wires) Levees Public [ ] Private [ Waterway Name Location of damage/problem Obvious hazards Nearest Landmarks Overflow/freeboard a ies- ( ] OES [ 1 Agriculture ( ] Health ( 1 Fire [ J Building ( 1 Sheriff T` 'PERMIT NO. 813-75B P • t' - - E M 'MH UTIL. PERMIT NO. PERMIT EXPIRES OWNER W,Ynoka Homes 'CONTR. t •`OCATION (A.P. 36-56-44 ) a 5.377 Cre stridge Dr., Oroville r Temp. Power Pole Called PG&E .ZeFpp. lec. Serv. % 5 Called PG&E Ttenp,. Gas Serv. Called PG&E JOB FIINALED J 7.f' l (Date) (Signatur 4L THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE CURRENT REGULA- TIONS, CALIFORNIA ADMINISTRATIVE CODE, TITLE 25, STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT: Street Lot Number Tract No. EXTERIOR WALLS��[� ManufacturerL,,_ 1 `^, ` Thickness/Type 3/"L.. R Value l CEILINGS Batts: Manufacturer Thickness QR Value Blown: Manufacturer ^� �� Thickness 0 3&1 No. Bags Wt./Bag Sq. Ft. Covered R Value 1 FLOORS Manufacturer Thickness/Type R Value SLAB ON GRADE Manufacturer Thickness/Type R Value Width of Insulation inches FOUNDATION WALLFR"�`g�V���° M ufacturer P1.0. Box T660 Thickness/Type R Value Ile, Calif. c;;;': G GENERA NIRA LICENSE No. BY J s TI JU —DATE ' INSULAI' N CONTRACTOR/HAWKINS INSULATION CO. LICENSE No. 215-925 BY TITLE DATE— 7�� o �l��r'c.Go �.� < s tNl Go%�% ��G��� �. U H��i✓ 5 /��l ' COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING etback /} Forms Subpanels Main Bldg. Footings 7. Stemwal I - ? Slab -/y.• - -.7 Piers 7 Garage Temp. Pole Footings -ZZ -' Stemwa I I Underground Slab '" "14 - - Carport Temp -Gas Footings Sanitation Slab Final Patio Footings Rou h Masonry Walls Fixtures Reinf. Steel Motors Bond Beam Water Htr. Framing Firewall Parapets Restroom Finish Windows `.2 -7-2F— Siding Roof Sheathing Z -Q. Roofing 6 - ZL! Fdn. Vents �— Garage Vents -- Prov. for physically handicapped Conformance of ex. structure i Final 19?' 4 ^FIREPLACE Footinq / FIRE SPRINKLERS Soi I Piping 1st Floor Subpanels 2nd Floor 3rd Floor Grd. Fault Prot. - �i To out _ Water Piping Service 3, % Sewer 7 Fixtures Temp. Pole Water Htr. Heaters Underground Appliances Gas Piping & Test Temp -Gas -- Sanitation Final Final DATE ELECTRICAL Rou h _ '7 Fixtures Motors Water Htr. Stucco Final Subpanels Mesh MECHANICAL Grd. Fault Prot. - �i Scratch Heating Service 3, % Brown J'-� 7 Cooling Temp. Pole Finish r Ducts Z Underground Interior Lath Ventilation - Permanent Door Closer 7 7 Final Final - DATE REMARKS OR CORRECTIONS 7S ✓ C�0 — - 't ( i1 7 lwrd-� 3 � x COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 3071-7" 7 County Center Drive - Orovijle, California 95965 Tel ep6one: 53$-4541 APPLICATION AND PERMIT V,' authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X Date 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 hav en paid. O OF BLIC WORKS By Date A - Building g permit e*pixss-Date a/.3 -% T— BUILDING Owner ��D�A � SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace Contractor /t/li Total Valuation Mailing Address ��� p 1�.. Permit Fee Plan Checking Fee&/or Penalty Telephone No. _ a Permit Fee Building Address PLUMBING No. @ FEE PERMIT FILING FEE $3.00 7 '7�� O e2kf Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent j 1.50 A. P. No. 6 -� �� ^ Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fees W.C. Sanitati-en' Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration Parcel Ma p 60' R/W Improvements p Lawn sprinkler system 2.00 44 s ec d Parcel Approval Plans Approval Permit Fee $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER Q 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 2 Receps., switches & fix outlets 20 0 25iin 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: l /J 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.—ZS-3 Z Classification 7/l� Misc. wiring ❑ 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. XI 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 Heating C11 Cooling Ventilation Hood 2.00 Permit Fee $ / $ ,67 100 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 relatinq to buildinq construction, and hereby TOTAL PERMIT FEE $ o? authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X Date 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 hav en paid. O OF BLIC WORKS By Date A - Building g permit e*pixss-Date a/.3 -% T— COUNTY OF BUTTE — DEPART)AENT OF PUBLIC WORKS 7 County Center Drivae —, Qroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT License No-27o<o/0 Classification 4!f—/d-'2 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 Code which requires every employer to be insured against liability forWo�rken's Compensation. 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. 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. Date Si X�.,�v�P� /�.O/iS�T� � gnoture of Permitee or Agent Receipt No. —, !n White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant _ BUILDING SQ. FT.7 DEC. I BUILDING VALUATION Fireplace $ Owner l��ho�o /Torhef 1 yic ELECTRICAL Mailing Address pe--> FEE Opo vi /e Telephone No. —17,78 Contractor $ Mailing Address ^ h , er No.1 @ FEE PERMIT FILING FEE Telephone No. Building Address �77 G relfr; a�4,o Ds- �r� v i' //e- 1.50 Water piping 1.50 Each gas water heater or vent 1.50 A. P. No. �lp '--j'� —Ll Zoning & Planning F .30 Sanitation Fire Dept. Fire Zone 2.00 Use Permit EQA Parking Plans Parcel Declaration Parcel Ma p 60' R/W Improvements p Bldg. Plans Recd I Parcel Approval Water pump Plans Approval NEW ADDITION ❑ UTILITIES ❑ OTHER f=aclo J�ffi.T-' ,FZ3--747 Temp. Power Pole Single Family Duplex ❑ Mobil Home ❑ Others ❑ Misc. wirinq 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-27o<o/0 Classification 4!f—/d-'2 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 Code which requires every employer to be insured against liability forWo�rken's Compensation. 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. 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. Date Si X�.,�v�P� /�.O/iS�T� � gnoture of Permitee or Agent Receipt No. —, !n White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant _ BUILDING SQ. FT.7 DEC. I BUILDING VALUATION Fireplace $ Total Valuation ELECTRICAL Permit Fee FEE Plan Checking Fee &/or Penalty $3.00 Permit Fee $ PLUMBING No.1 @ FEE PERMIT FILING FEE $2.00 Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Building sewer 5.00 Lawn sprinkler system 2.00 Permit Fee $ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 ,Oa Main service incl. 1 meter 67.- poAdditional Additionalmeters,each 1.00 Sub -panel (12 o ess) (more than 12) Ra ge, Cook -top or Oven 1.00 ,po Water Heater or Space Heater 1.00 Light fixtures 20P25 bol d10 , 7:r —i Rep1m., swi es & fix oJets M 0100 Hood x. Fan or F. A. Furn. Motor 1.00 ,00 Evao. cooler, gar. disp. or D.W. 1.00 , Oo Air conditioner or heat pump Water pump Mobil Home Facilities 5.00 Temp. Power Pole 5.00 Misc. wirinq Permit Fee $ MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Coolin Ventilation Hood 2.00 Permit Fee $ .4 - TOTAL TOTAL PERMIT FEE J$ a/ This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above for which e Ove been paid. `ECTOR 0 _JBLIC WORKS B Date�� g permit expires Date ........ �..�............... J COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — 0ToviIle, California 95965 Tel ephone: 534-4541 APPLICATION AND PERMIT Owner IM7 AJp< Kt---, i M6 Mailing Address f o. zfOk I1aB Telephone No. s� --27 3 Contractor ' el— Mai 'LMai I i ng Address g -sL Telephone No. 1J7 �/o c7 Building Address , n 16Q 4- A. P.No. '36'--s6 —44- Zoning & Planning ls FeW'C/1 �)r�Vi�r Fire Dept. Fire Zone Use Permit EOA Parking Parcel Parcel Ma 60' R/W Im rovements Plans Declaration p p Bldg. Plans Recd I Parcel Approval Plans Approval NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER & Single Family © Duplex ❑ Mobil Home ❑ Others ❑ CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Proessions Code under the name style of• License N Classification -3 -� 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 Code which requires every employer to be insured against liability for Workmen's Compensation. 19 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. 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 fo' spection purposes. 4,7e�l- Date Signature of Permitee or Agent Receipt No. Z 02 9 3 a White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant / J 75 1/ BUILDING SO. FT. I OCC. I BUILDING VALUATION Fireplace b 01%S ELECTRICAL No.1 @ FEE Total Valuation J$3.00 Main service incl. 1 meter Permit Fee 1.00 Sub -panel (12 or less) (more than 12) Plan Checking Fee &/or Penalty 1.00 Water Heater or Space Heater 1.00 Permit Fee y %210 Receps., switches & fix outletsbat 0 10 PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 Each Trap 5.00 1.50 /2,00 Repair drainage or vent piping 1.50 Water piping 1.50 /.6-40 Each gas water heater or vent 1.50 t, j v Gas piping system 1 - 5 outlets 1 1.50 i. V Each additional outlet .30 Building sewer 1 5.00 ,S ..o0 Lawn sprinkler system 2.00 Permit Fee b 01%S ELECTRICAL No.1 @ FEE PERMIT FILING FEE J$3.00 Main service incl. 1 meter Additional meters, each 1.00 Sub -panel (12 or less) (more than 12) Ranqe, Cook -top or Oven 1.00 Water Heater or Space Heater 1.00 Light fixtures y %210 Receps., switches & fix outletsbat 0 10 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 Misc. wirinq Permit Fee $ MECHANICAL No. @ I FEE PERMIT FILING FEE J$3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ TOTAL PERMIT FEE $ 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. DI EC,TOR F PUBLIC WORKS Btu==' Date Sc� Building permit eMpiFe Date COUNTY OF BUTTE — DEPARTMENT OF PUBLICWO C.> IS— Telephone: ^ 1 5— 7 County Center Drive Qroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT auuruncr iupiubentauveb ur me tJuunty ur twtte to enter upon me above -menti ned property for, pection purposes. z X Date o3 /o Zr` nature of Permigent Receipt No. a ltee or 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 PUBLIC WORKS By,,4Date Building permit expires Date.......... BUILDING Owner&zdf�—e/ SQ. FT. OCC. BUILDING VALUATION Mailing Address . / ` Telephone No. r ) Fireplace Contractor Total Valuation Mailing Address Permit Fee ,® Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ $ Building Address ` �� PLUMBING No. @ FEE PERMIT FILING FEE $2.00 Each Trap 1.50 Repair drainage or vent piping 1.50 wi _ Water piping 1.50 Each gas water heater or vent 1.50 / A. P. No. ✓ �— . — Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 F es I W.C. Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA I Parkin Parcel Plans Declaration Parcel Ma P 60' R/W Im rovements P Lawn sprinkler system 2.00 I g ans Recd Parcel proval Plan pproval 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 zu Id d1) Receps., switches & fix outlets 20 25 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: %�%�� 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 �/ .19—/ License No._� %�f� g. 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 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 $ $ 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 TOTAL PERMIT FEE $ auuruncr iupiubentauveb ur me tJuunty ur twtte to enter upon me above -menti ned property for, pection purposes. z X Date o3 /o Zr` nature of Permigent Receipt No. a ltee or 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 PUBLIC WORKS By,,4Date Building permit expires Date..........