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Home My WebLink About078-250-011Alvis San as z j,6 •.7'� 58 Hoover S't lot 6, Hoovers Sub,Oro. Permit #6329-77B(reroof/SF). COMPLAINT TO INSPECTOR s —6-4-2057 . 5 HUMES, DAVID T. .r 58 HOOVER ST, OROVILLE Cont: GREENE ROOFING REPLACE SEWER LINE Y - -_ 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 PERMIT NO. BP042057 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: 07/13/2004 • APN: 036-091-015-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 58 HOOVER ST ORO Date: Contractor: Map Index: Description: REPAIR EXISTING LINE TO LOAPUD Descrp - 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 Owner: DAVID AND JANELLE HUMES to its issuance, also requires the applicant for such permit to file a 725 WRAY CT 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 OROVILLE, CA 95965 she is exempt therefrom and the basis for the alleged exemption. Any 530-534-3453 violation of Secfion 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: DAVID AND JANELLE HUMES pp Code: The Contractors' State License Law does not apply to an owner of property who builds op improves thereon, and who does such work himself 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 Contractor: 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.). ❑ I am Exempt under Article 3 of the Business and Professions Code r"�-dr Date: Owner: License #: WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I 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. ❑ 1 have and will maintain workers' compensation insurance, as Engineer: 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: Total Square Ft: 0 S. F. Policy a: Valuation: $0.00 Census Code: 1 certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith those provisions. `pcomply 'with �` ' d `f Date: 7I Applicant:_nri$ l 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. ' It—/ CONSTRUCTION LENDING AGENCY Thispermitis hereby issued under the applicable provisions of the Butte County Cods and/or 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.) above for which fees have been paid. w s i ted Resolutions to do _ ��J - Name: B y' Date J v v� PERMIT EXPIRES ON: t• Address: Date ❑ 1 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. O 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. 1 hereby authorize representatives ofButte County to enter upon the above mentioned property for inspection purposes. Print Name: �% f '/ �'� j Signature: ( ,'-" Date: wrier ❑ Contractor 0 Agent for Owner ❑ Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS C 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION "PLEASE PRINT CLEARLY" OWNER Last Namel/ E i ame 1 Address 2� �/ rL All c City �_� State Zp Phone 3 Fax Email CONTRACTOR Name F"M c� .r s7 Address City �� Stated Zipg,�&� Phone Lf --39 C90 Fax E-mail Lic. 'Co f 1 0 - -7 1 Class APPLICANT NAME ARCHITECT/ENGINEER Name City Address SRA City Fax State ZIP Subdivision Name Map Book Fax E-mail Planner State License Number APPLICANT NAME Name �•\ Address City State SRA Phone Fax Email APPLICANT SIGNATURE For office use only: Zoning AP# Flood Zone Pro ddr s SRA I Yes I No Occ• Type Const. Subdivision Name Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:T0RMS\RUILDINr; FnRMC\RIrinAnntCihRnrnM .i.. PERMIT . �b5 BP BIN # Description or Scope of Work: 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 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: `J LOCATION AP# Pro ddr s Sheriff City Cross Street WORKER'S COMPENSATION Policy Number Carrier ffhiring anyone other than license contractors, a certifficate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address Description or Scope of Work: 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 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: `J ------ Bldg SRA Receipt0#; w (\(/� Sheriff SMIP I Date: }%JJ & I ,� ` Other •_ Total SUBMITTAL REQUIREMENTS The following drawings and specifications must be submitted to the Building Division in order to apply fora permit. INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK. Residential, New, Remodels, Additions, and Accessory Structures: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPER! ❑ 2. 3 Complete sets of plans, signed by the preparer. NO GRAPHPAPERI OR 3 Sets Engineered plans (if required) with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation. (Note: Not required for additions to mobile or modular homes.) ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Detached Accessory Building Form, filled out by the property owner (if required). ❑ 8. Sanitation and site plan approval from the Environmental Health Department. ❑ 9. Metal Buildings: (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. Mobile, Manufactured, or Modular Homes: ❑ 1. 3 Site Plans, signed by the preparer. NO GRAPHPAPERI ❑ 2. 2 Data sheets and installation instruction manual. ❑ 3. 2 Marriage line information. ❑ 4. 2 Floor plans. 115. 2 Engineered Tie Downs or Foundation plans. ❑ 6. Sanitation and site plan approval from the Environmental Health Department. ❑ 7. 2 Flood Elevation_ Certificate, wet -stamped and signed (if required). Commercial, New, Additions and Remodels: ❑ 1. 4 Site Plans, signed by the preparer. NO GR, PHPAPER! ❑ 2. 4 Engineered plans with wet signature on plans AND 2 sets of stamped and signed calculations, with code analysis. ❑ 3. 2 Engineered truss details and layouts (if required) (NO FAXES!). ❑ 4. Letter from Engineer or Architect for truss design review. ❑ 5. 2 Energy compliance design and supporting documentation (if required). ❑ 6. 2 Flood Elevation Certificate, wet -stamped and signed (if required). ❑ 7. Statement of Intent for Non -heated and A/C (if required). ❑ 8. Metal Buildings: (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-sigged by the engineer. ❑ 9. Letter of intent. ❑ 10. Hazardous Material Form. ❑ 11. Sanitation and site plan approval from the Environmental Health Department. If you have questions or would like additional information regarding this process, contact a Permit Application Assistant at (530) 538=7541.' - OVER FOR BUILDING PERMIT APPLICATION KAFORMBUILDING F0RMS\BIdgApp1SubRgmts.doc Page 2 of 2 REV 6-16-04 �. �, i .. ;y...r ti"! Vic. r �--;?.-� . 1:'+,'� ,.. - _..-,=--•ff•:F.- �. ..'.ri:.r„�� ,--�X,.»n...t�.r:^.F':-t�.., ��'^ - "r-T`y ....:x,.-,i.� � .. .� °,.t". � ... -- . COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION ;r 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET OWNER: l/Y , lX� ASSESSOR PARCEL NUMBER O'��to ' v , - O I / Proposed Building Use:`(`(1�� i Counter Technician. Date: ' Items required in order to app/ for a permit. All boxes 9,9S , be checked OR marked NA in order br pply. ! ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of h lans.. t ❑ 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 faxes! ❑ _ 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 AIC for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Data sheets and installation inst, (B) 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. Site plan and business license approval from the City of Biggs ❑ 12. Letter of intent for non-residential buildings ❑ 13. Detached Accessory Building Form filled out by the owner ❑ 14. Hazardous Material Form ❑ 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable. ❑ 16. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 17. Fire Sprinklers............................................................................................ ❑ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 19. Soils Report and/or Engineered Foundation required ........................................... ........ ❑ 20. Erosion Control Plan Required...................................•.................................... ........ ❑ 21. Fees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ 22. City of Chico Plumbing permit........................................................................ ❑ 23. California Department of Forestry plan approval ❑ paid. Sent by: ......•...... ❑ 24. Planning approval (A) Use: (B)Parking: (C) Parcel Check: ❑ 25. Contact Land Development about _ Improvements, _ Drainage ......................... ❑ 26. NPDES Form..........................................................................•.................. ❑ 27. Encroachment Permit for driveway from the Public Works Dept ........................... ❑ 28. Pre -Inspection for required....... ❑ 29. Contractor's license information (Number, Name Style, Classification) ................... C3 30. Worker's Compensation Carri f and Policy Number .......................................... :17 31. Owner -Builder Verification (Given to owner, _Mailed to owner) ..................... 32. Letter of Signature authorization........................................................... ......... . ❑ 33. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 34. Manufactured home utility clearance............................................................... ❑ 35. Existing violations and/or expired permits......................................................... ❑ 36. Deed Restriction......................................................................................... ❑ 37. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, ❑ Check to H.C.D. $ ❑ 38. Other: ❑ 39. Other: 1 When issued Telephone and hold for pickup. I have been informed of the above items and requirements for obtaining a building permit. Applicant: ` /� / . Date: 7 /1 y 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: Plans reviewed by: Date: Plans approved by: Date Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division Lake PERMIT NO.. e Area Public Utility District 1960 Elgin Street OROVILLE, CALIFORNIA 95966 533-2000 DISTRICT APPROVAL AND VERIFICATION OF INSPECTION BUILDING SEWERS This verification form must be submitted to the Butte County Department of Public Works Building Department prior to issuance of a building or occupancy permit, whichever is applicable. Prior to final approval by Butte County of a Building or an Occupancy Permit, a copy of this verification form, signed off by Lake Oroville Area Public Utility District, must be submitted to Butte County. Date: July 13, 2004 Applicant: DAVID HUMES Applicant Address: 725 wray Ct. oroville, _ CA 95966 Applicant Phone No.: 534-345 Property Locations(s): 58 Hoover Street A.P. No.(s): Fees due: Hoover Subd. Lot 46. 36-091-015-0 No fees due. Replacemnet of existing Lihe. Application for service approved: LAKE OROVILLE AREA PUBLIC UTILITY DISTRICT Inspection(s) made and successful test(s) observed: Location: A -- Lake Lake Oroville Area Public Utility District release to close permit: Date: 0 Date: OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner-buildee' 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 materials for construction of the proposed property improvement: YES P- NO ❑ I HAVE ❑ HAVE NOTRsigned an application for a building permit for the proposed work. I have contracted with the ollowing person (firm) to provide the proposed constriction: NAME: ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: NAME: ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. S. 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 1 IGNED: PROPELRTYOWNEPX DATE: —7 / r f o NOTA: This Owner -Builder Verifuaatiion is required by Section 19831 and 19831 of the California Health and Safety Code. This verification mast be completed and returned to our office before we are permitted to issue the permit 0VFR OB. -I I OWNFR BUILDER FORMATION Dear Property Owner. An application for a buildingpermit has been submitted in your nam listing yourself as the builder of property improvements specified. For your Peron, you should be aware that as "owner builder" you are the responsible party ofrecord on such a permit. Building permits are not required to be signed by property owners unless theyare personally rm>ag own work, If your work is be' P naIIy perfo their ung 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 regnked 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 you plan to subcontract, you should be aware of the following information for your benefit and protection: 0 Ifyou employ or otherwise engage any persons other thaw your immediate famuly, and tine work (including materials and other costs) is $300 or more for the entire project, and such persons are not licensed as comracbars or subconracbms, then you may be an employer. ♦ If you are an employer, you must register with flee State and Federal Governments as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance costs, and unemployment compensation comriburtions. ♦ There may be financial risks for yon if you do not casy out these obligations, and these risks are a �,,Wl with respect to worker's compensation hwurzwe �P'n"a'�7 serious ♦ For more speci$c hfim mdOn about your obligations under Federal Law, contract the internal RevenueService (and, if yon wish, the U.S. Small Business Administration). For mare specific information about your obligations under Stam Law, contact the Department of Benefit payments and the Division of industrial Accidents. If the strnctUre 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 contracWr or subcontractor, only under limbed conditions. A frequent practice of unlicensed Persons professing to be contractors is to secure an "owner builder" building Pea, erroneously implying that the property owner is providing his or herr own labor and material ers B permits are not required to be P oy ufi inion about � signed � ProP�Y owners �� are Pig their own wow personally. cOntractors may be obtained by contracting the Contractors State License Board in your communis' or at 102014 Street; Sacramento, CA. 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you are aware of these matters. The building p=at will not be issued rxmi the verification is returned. NOTA Hits Owner-Buffde rrnform ewn is required by Section 19830 ofthe California Hea1Bt and Safety Code QERMIT NO. 6329-77B PERMIT EXPIRES OWNER Alvis Sanders CONTR. Owner LOCATION (A.P. ' 36-091-1 ) 58 Hoover St., lot 6, Hoover Sub, Oroville 0 Temp. Power Pole Called PG&E Temp. Elec. Serv. Called PG&E Temp. Gas Serv. Called PG&E JOB FINAL EDD (Date) �N (Sig ture) i COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING Setback Firewall Soil Pipin Forms Parapets 1s Floor Main Bldg. Restroom Finish 2nd Xloor Footings Windows 3rd F or StemwaII Siding To out / Slab Roof Sheathing Water PIplhg Piers Roofing IE Sewer Garage Fdn. Vents Fixtures Footings Garage Vents Water Htr. Stemwal I Insulation Heaters Slab Carport Footings Prov. for physically handicapoed Conformance of ex. structure Appliances Gas Piping & Te t Temp. Gas Slab Final Sanitation Patio FIREPLACE Final Footings Footing ELAtTRICAL Masonry Walls Throat Rough Relnf. Steel Final " Fixtures Bond Beam FI_RSPRItJLERS Motors Framing Test Water Htr. Stucco Final Subpanels Mesh ME NICAL Grd. Fault rot. Scratch Heating Service Brown Cooling Temp. P le Finish Ducts Under r and Interior Lath Ventilation Pennane t Door Closer Final Final MOBILEHOMEUTILITIES------------------ Elec. Service Elec. Pedestal Water Piping Sewer Gas Piping E ME INSTALLATI N - - - - - - - - - - - - - - Support Elec. Continuity Water 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 — Uroville, California 95965 Telephone: 53 4-4541 APPLICdTION AND PERMIT S� authorize representatives of the county of Butte to enter upon the above-mentioned property for inspection purposes. X Cz.Gr.._.��. Z.tw Date '_--- Signature of PPermjitee or gent Y Receipt No. 1 U. Q 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 P BL C WORKS By . to /Z- _6 — 7 7 Bring permit expires Date /y-6-7 BUILDING Owner SSQ. f T. OCC. BUILDING VALUATION Mailing Address' J S ephorlg o. ,,,�� Fireplace Contractor ".A 1A Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ r Building Address v - PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1.50 V i l 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 - �actit3tin� 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 Parcel Approval Plans Approval Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No.1 @ I FEE PERMIT FILING FEE J$3.001 `••' Main service 600V 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 R 600V OOEAMP OR LESS 25.00 Main service EA. ADD -L 100 AMP 1.00 NEW CONS. DWELING O OR ADDNST ( ACCLBLDGS,CCUP. &) 22sgft NEW CONSTR. (MULTI -OUTLET NON.RESID. BRANCH CIRCUITS) 12.50ea NEW CONSTR. POWER APPARATUS & NON.RESI 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 st le of: y Ex. Occup(OUTLETS OR FIXTURES) @251O a Ex. Occu FIXED APPLNS. OR P• OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. Classification Misc. Wiring 6.25 ® I am exempt from the Contractors License Laws of the State of California. Permit Fee $ 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 Cz.Gr.._.��. Z.tw Date '_--- Signature of PPermjitee or gent Y Receipt No. 1 U. Q 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 P BL C WORKS By . to /Z- _6 — 7 7 Bring permit expires Date /y-6-7