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HomeMy WebLinkAbout078-260-001Gloria ���igha�%�� 4960 �, Oroville Permit 713-77P,E(util.,MH) IT ELEC.�a3 GAS SUPPORT STAUCTURE REQ.i/,� COMPACTION TEST REQ. oyo Y -6-882-36 contr: Wilson Mobile Dome Serv., Oro. Permit #2718-77MHI Issued — l� contr: Wilson Mobile -Home Serv.,Oro.; Permit #3121-77B;M(reinstall awning. w/deck & A/C & carport/MJ?) 0`1g a -Co°- °'°I O/� i tom- Gloria ���igha�%�� 4960 �, Oroville Permit 713-77P,E(util.,MH) IT ELEC.�a3 GAS SUPPORT STAUCTURE REQ.i/,� COMPACTION TEST REQ. oyo Y -6-882-36 contr: Wilson Mobile Dome Serv., Oro. Permit #2718-77MHI Issued — l� contr: Wilson Mobile -Home Serv.,Oro.; Permit #3121-77B;M(reinstall awning. w/deck & A/C & carport/MJ?) 0`1g a -Co°- °'°I O/� t 4A } PERMIT No. 1713-77B,E PERMIT EXPIRES ;OWNER Gloria Vaughan CONTR. owner LOCATION (A.P. 36-082-36 4960 Hearst Ave., Oroville i >X 1, P, y Cof SCt-foo Temp. Power Pole Called PG&E Temp. Elea Serv. Called PG&E Temp Gas Serv. %Called PG&E W— N ALED Moor Closer FinalFinal MOBILEHOIVIEUTILITIES Elec. Service Elec. Pedestal��' l3 yid` Water Piping Sewer t� Gas Piping MOBILEHOME INSTALLATION .... • . • . • • • • Support Elec. Continuity Water Piping Drainage Gas Piping DATE T REMARKS OR CORRECTIONS 0 �,�,, �� or i s�, ®vim 1-'ttev7 ®! AtS 4—A �(� SAS L-1 t a4 a+•soca t.u-y. • 200 -� � -Yl0-.SS-710 C•2 . OlIV77 70 �c � (NOTE: An entry must be made on this form each time you visit the jsite COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING Seltack F ewall So'V Piping Fornk Par ets I 1 Floor _ Mai Bldg. Rest om Finish 2n loor Fc, ins WlndoA 3rd koor Stem all Siding To out Slab Roof Shealbina Water PIAO Piers Roofing Sewer Garage Fdn. Vents Fixtures Footin s Stemwa I I Garage Vents Insulation j.j Water Htr. ' Heaters Slab Carport Po Footings Prov. for physical handicapped Conformance of ex. V V structure Appliances Gas Piping & Test Temp. Gas ' Slab Final Sanitation Patio REP ACE Final Footin s Footing E ECTRIC L Masonry Walls Throat Rou h Reinf. Steel Final Fixtures Bond Bea FIRE SPRINKLEA Motors Framing Test Water Htr. Stucco inal Subpanel Mesh MECHANICAL Gird. FAR Prot. Scra h qHeatl1(g Servio n nB og T mp. Pole nish is Anderaround Moor Closer FinalFinal MOBILEHOIVIEUTILITIES Elec. Service Elec. Pedestal��' l3 yid` Water Piping Sewer t� Gas Piping MOBILEHOME INSTALLATION .... • . • . • • • • Support Elec. Continuity Water Piping Drainage Gas Piping DATE T REMARKS OR CORRECTIONS 0 �,�,, �� or i s�, ®vim 1-'ttev7 ®! AtS 4—A �(� SAS L-1 t a4 a+•soca t.u-y. • 200 -� � -Yl0-.SS-710 C•2 . OlIV77 70 �c � (NOTE: An entry must be made on this form each time you visit the jsite M0Bj-J,-EHQ-%1E` INS1.'ALLAT-IM4 INSPECTION. CHECK LIST 1. Is the mobilehome located w'.I.h quired separation from lot lines and buildings and generally conform to plot plan? Yes No 2. Does they mobilehome have requirecl clearances above ground? (Sec.5085) YNo 3. Are footings and supports properly sized, spaced, and braced as er approved plans? (Note possible varication at spring shackles.) (Sec. 5082 & 5083) YesNo_ 4. Is the mobilehome level.? (Sec. 5088) Ye� No 5. If m than a single unit, are crossover connections properly installed? (Sec. 5088) Yesyo 5. Water A. Is = exi e connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes No B. Test - Does water piping withstand working ? / • p p g g pressure or 50 lbs, air test. Yes " No C. Backflow - If coach is not State of Ca f a pproved, does station have backflow device and pressure -relief valve? Yes No 7. Wastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes No B. Does it have minimum ," per foot slope and is it properly supported? Yes— No C. Are any leaks detected in drainage system after runnin�j 3 -gallons of water through each fixture including washing machine standpipe? Yes Nod/ D. If coach is notof California approved, does station have required trap and vent? Yes No A41, 8. Gas Piping and Gas Vents A. Connector - Is mobilehome connected to the gas supply with an approved 3/4" minimum mobilehome connector not more than 6 ft. long? Note: All piping is to be at least as large as the.mob'1 eye gas line inlet without reductions other than the mobilehome connector. Yes No' B. rest OK as per following procedure? YeSV_ No 1. Open all appliance connector valves. 2. Shut off appliance burner and pilot valves. 3. Air test with manometer to 10"-14" water column, or test with slope gauge (minimum 6oz.-maximum 8 oz.) calibrated in tenth pound increments. Test for '10 min. without drop. 4. Connect: gas meter to mobilehome with connector, turn. on gas, test connections with soapy water. C. Are all appliance vents properly installed? Yes VN0 9. Electrical. A. Is sei-vice large enougl: to provide adequate amperage to mobilehome (must equal -rating of mobilehome (aith a ::,inia;aumf 00 amp) and other facilities on lot, i.e., water pumps, garage, cabana, etc.? Yes- 0_- B. Is there proper clearances around panels? Yes No_ i C. Is power supply cord or feeder assembly properly fused? Yes No_ D. Is continuity test satisfactory as per the following procedure-.? Ye No 1. De -energize electrical -airing syste:ri of the mobilehome at the p estal. 2. Make sure that the power supply cord or feeder assembly conductors, including neutral" conductor, have been disconnected. 3. Switch all breakers, and switches in the mobilehome to the "on" position. h 4. Connect one load of a test instrument to the mobilehome grounding conductor and apply tl'.e G�Lie lead to each mob Lk lLL LC Supply CUYiuLiCtGr, lllCliii111tg itC,litat. 5. All nor. -current, carrying metal parts of the mobilehome (aluminum siding, gas line, water line), including fixtures and appliances, shall be tested for continuity from such egiiipment and the grounding conductor. 6. Upon completion of the above procedure, the power supply cord or feeder assembly conductors shall. be connected to the site service equipment. A further continuity te:;t shall then be made between the grounding electrode and the chassis of the rlobilehome.. Upon satisfactory completion of theelectrical tests, the lot or site service equipment may be approved for energizing. job card signed by health Department for` water and sanitation? 1.1.. If everything olcay, sign off card and tag- services. tiiUlilLi i(U!^,.L DATA 1 Manufacturer and/or Namestyle -X-t. Length© Width Vehicle Serial No. 2�_5 - . S� � 5 State Identification No. __. Adcs.Ltional Information or Comment,-,,: COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE OROVILLS, CALIF. - 534-4541 CERTIFICATE OF OCCUPANCY This mobilehome has been installed in accordance with the requirements of the California Administrative Code, Title 25, Chapter 51 under permit number % for the following location: i Owner Owner's Address Mobilehome Mfg %%;� %� Model Year Insignia No. _ �� => Serial No. It is hereby certified for occupancy at the above described location and may be occupied. Director of,Public"Works Date By THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED "COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — Uroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT / 743 JAV i � authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X C/ ate 1�1Signature of Permiteelor Agent Receipt No. 14,0 �,yq 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, )JBLIC WORKS By Date Y ,Z-- 7 % Building permit expires Date BUILDING Owner L O44, /pl 04 y tvw SO. FT. OCC. BUILDING VALUATION Mailing Address S i D Telephone No. 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 $3.00 L{g°per Each Trap 1.50 /� ' 0 Repair drainage or vent piping 1.50 Water piping 4 -5e - toning Verifitefion OnIv Each gas water heater or vent 1.50 / A. P. No. 3 Zoni & n Gas piping system 1 - 5 outlets 1.50 Q Each additional outlet .30 Fee f//3 vo. W!. citation Fire Dept. Fire Zone Use Permit Building sewer 0 " EOA Parking I Plans Parc I Decla tion Parcel Ma p 60' R/W Im rovements p Lawn sprinkler system 2.00 Bldg. Plans Recd cel Approval Plane Approvol Permit Fee $ $13160 NEW ❑ ADDITION ❑ UTILITIES © OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 300 OR Main service 80000 AMP+ORSLS ESS 5.00 00 Main service EA. ADD'L 100 AMP 2.50 2-S-0 Main service OVER 600V 25.00 100 AMP OR LESS Single Family ❑ Duplex ❑ Mobil Home 1�71 Others ❑ Main service EA. ADD•L 100 AMP 1.00 B.w $Q. FT. MINIMUM NEW CONST. DWELLING OC.cUP. & ACC. LN G0 2¢Syft OR ADDNS. ( I NEW CONSTR. MULTI -OUTLET NON-RESID, ( BRANCH CIRCUITS) 2.50ea NEW CONSTR. POWER APPARATUS 9_ NON-RESID. (SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the ' State of California Business & Professions Code under the name style of: t 50@ 254t Ex. Occup(OUTLETS OR FIXTURES) gg Ex. Occup. (OUTLETSP(RESID)REA) 2.00 Temporary service 10.00 e Mobile Home Facilities 15.00 S pa License No. Classification Misc. Wiring 6.25 I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ 1S S'7 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. ❑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. 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 relatinq to buildinq construction, and hereby 4R'tir U/Z .., T 5" Ud TOTAL PERMIT FEE $3 �Z authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X C/ ate 1�1Signature of Permiteelor Agent Receipt No. 14,0 �,yq 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, )JBLIC WORKS By Date Y ,Z-- 7 % Building permit expires Date NOTE:—All Materials & Workmanship Shall Be in s This so►�, of plans and ca ions MUST -6e Accordance with Recognized Good Practices and 'kept on the fob at all times and it is unlrwful to of a quality prescribed for the Specified use. -in the make any changes or alterations oh some without' 'Uniform Building, Plumbing' & Mechanical Cortes and written. permission from the D6parfinent 6f Public the National Electrical Code. Works, County of Butte, The'' . SetS. vck shall be 5 ft. from the . l I s1de property lire and 50 ft. from the cenfer'lire of the road,. permitting a maxi- 'mum of a 2 ft, eave overhang but entirely out of all easements. A permit will be re installation of the - J' i AIV utility connections shall. lie located -within # ft. outside the rear third section 'of the mobile home on the left (road) side of the mobile home. J6 SUE COUNTY t> BUILDING DEPARTMENT , APPROVED I� �s J6 SUE COUNTY t> BUILDING DEPARTMENT , APPROVED I� COUNTY OF BUTTE" — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — Oroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT 6 authorize representatives of the County of Butte to enter upon the above-mentioned property for 'inns—p-ection purposes. ,.,Date 4-a2 —77 Signature of R~ iitee or Agent Receipt No. 1,610 _/ 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 UP PUBLIC WORKS By l Date 7 7 B ' ding permit expires Date —I`/ - 7� BUILDING Owner �C.o� ,� ���� �� Q,1% SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace Contractor L A14 Total Valuation Mailing Address � � Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ Building Address PLUMBING No.1 @ FEE FILING FEE $3.00 �sPERMIT Each Trap 1.50 r/ Repair drainage or vent piping 1.50 Water piping 1.50 Each gas water heater or vent 1.50 p A. P. No. _3(O DO?— ( 6 Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 F on I Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration Parcel Ma p 6 ' R/W Im rove is p Lawn sprinkler system 2.00 Bldg. � Recd Parcel Approv Plansproal Permit Fee $ $ NEW ❑ ADDITION �UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 .�,f �p� / /�- _/" 10.1-/ .....77 600V OR LESS 5.00 Main service 100 AMP OR LESS Main service EA. ADD'L 100 AMP 2.50 Main service OVER 600V 25.00 100 AMP OR LESS Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service/ EA. ADD'L 100 AMP 1.00 (a / ,/�ij-V/� C �. GG+1I�Yt/• NEW C.rill.LING O OR ADDNS. ( ACCDWELBLDGS.CCUP. &) 20sgft NEW CONST R. MULTI.OUTLET NON.RESID. ( BRANCH CIRCUITS) 2.50ea NEW CONSTR. (POWER APPARATUS .&) NON RES,D. SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: h �d 7 ni/%� �Zf @ Ex. Occup(OUTLETS OR FIXTURES) BAL@1 109 IXED A Ex. Occup. (OUTLETS P(RESID )REA) 2.00 Temporary service 10.00 7 Mobile Home Facilities 15.00 License No. 216 7% Classification C11, _ Misc. Wiring 6.25 ❑ 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. 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 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 S ®Q TOTAL PERMIT FEE $ authorize representatives of the County of Butte to enter upon the above-mentioned property for 'inns—p-ection purposes. ,.,Date 4-a2 —77 Signature of R~ iitee or Agent Receipt No. 1,610 _/ 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 UP PUBLIC WORKS By l Date 7 7 B ' ding permit expires Date —I`/ - 7� BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA. PHONE: 534-4541 MOBILEHOME INSTALLATION SHEET 1. Owner's name: 2. Installer's name: i 3. Is the' site currently under permit? Yes. /!// No (If yes, furnish permit number / % / 3 % % ) OR Is the site an existing site? Yes / / No (If yes, furnish two (2) plot plans.) 4. Will the mobilehome be located at least 5 ft. away from sep is tank and leach fields and clear of all setbacks and easements? Yes / / No /,!/ ( If no, clarify 5. What is the mobilehome electrical rating? ----------------------- / Amps 6. What is the mobilehome site service rating?---------------------� Amps 7. What is the mobilehome site circuit breaker rating? ------------- Amps 8. Is there any other electric load to be served by the mobilehome site service? --------------------------------------------------- Yes / / No T_7 (If yes, identify the load and size: (Load) (Amps) 9. What is the mobilehome site gas pipe size? ---------------------- (in.) 10. What is the type of gas service? ----------------------------- Natural Z` LPG 11. What is the gas pipe length from meter or tank to the mobilehome? (ft.) 12. What is the mobilehome gas demand? ---------------=-------------- (BTU) (This information not required if pipe length less than 6 ft. on natural gas or less than 50 ft. on LPG.) MOBILEHOME SUPPORT DATA I r `Yda`r Mobilehome Mfr. - /---e:�' Setup Model No. Width ::2 (ft.) Length (ft.) .- Expando Size ft.x ft. (Draw support details below) +!+ On all mobilehomes manufactured after October 7, 1973, furnish manufacturer's installation manual and structural setup sheets (if not on .file with .the County of Butte). Sin le - s; Footings (check.one) _ / w�-1. Wood . either . pressure treated or, Center Center Support fdn-. grade. I Support Footing Sizes I Locations (in.) J % 2. Concrete pad. 'X 1g;3 x in. in. [.-� �x,.� (f0 7in7 in.)(in.) (ft. 3 kin.) 7 (in.)(in.) I i *If center piers are other than drawn above, draw in locations,.spacing; and dimensions. 3. Other,: specify Supports (check one) 147,11. Concrete block 2. Concrete piers i 3. Steel piers I 4. Other, specify ypical Support On§�&Mkooting Size 36) { r ........__ .._/.'.�_� Max. Pier L� Spacing ;i Max. j 3.n.Overhang BUTTE COUNTY BUILDING DEPARTMENT APPROVED PERMIT NO. 3121-77B3,M PERMIT EXPIRES W301)pe ¢. OWNER_ Gloria Vaughn CONTR. Wilson MH Serv., Orap ille LOCATION (A.P. 36-082-36 4960 VC Ave., Oroville Temp. Power Pole Called PG&E _ Temp. Elec. Serv.. Called PG&E _ Temp. Gas Serv. _ Called or_n_c FIFINALED t OLYG{iV rinai suo aneis Mesh MECHANICAL Grd. Fault Prot. Scratch Heating Service Brown Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation Permanent Door Closer Final Final MOBILEHOME UTILITIES ------------------ Elec_ Service Elec. Pedestal Water Piping Sewer Gas Piping MOBILEHOME INSTALLATION - - - - - - - - - -•- - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE REMARKS OR CORRE TIONS r (NOTE: An entry must be made on this form each time you visit the job site.) COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS . d ' BUILDING INSPECTIQN RECORD BUILDING BUILDING (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 Water Piping Piers Roofing Sewer Garage Fdn. Vents Fixtures Footings Garage Vents Water Htr. Stemwall Insulation Heaters Slab Carport Footings Prov. for ph sically handica edy Conformance of ex. structure Appliances Gas Piping &Test Temp. Gas Slab Final Sanitation Patio FIREPLACE Final Footings Footing ELECTRICAL Masonry Walls Throat Rough Reinf. Steel Final Fixtures t OLYG{iV rinai suo aneis Mesh MECHANICAL Grd. Fault Prot. Scratch Heating Service Brown Cooling Temp. Pole Finish Ducts Underground Interior Lath Ventilation Permanent Door Closer Final Final MOBILEHOME UTILITIES ------------------ Elec_ Service Elec. Pedestal Water Piping Sewer Gas Piping MOBILEHOME INSTALLATION - - - - - - - - - -•- - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE REMARKS OR CORRE TIONS r (NOTE: An entry must be made on this form each time you visit the job site.) r COUNTY OF 13UTTE — DEPARTMENT OF PUBLIC WORKS .j 7 County Center Drive — Oroville, California 95965 Telephone: 534-4541 APPLICA710N `AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. 7,►®ate Signature oof' Per itee 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 0 P BLIC WORKS By !' Date 6 —3 O— 77 Buiding permit expires Date ° ` 7 BUILDING Owner SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Fireplace Contractor IS67AIv ` 'l Total Valuation o� Q Mailing Address G�Q/ Permit Fee 40C Plan Checking Fee &/or Penalty Tele hone o. Permit Fee Q( Building Address PLUMBING No.1 @ FEE PERMIT FILING FEE $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. — fe� —176 Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 FL%/s C. S i ion Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration Parcel ap 60' R/W Improvements Lawn sprinkler system 2.00 Bldg. ans Recd Parcel Approval Plans Approval Permit Fee $ NEW F0. ADDITION ❑ UTILITIES ❑ OTHER ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 1 t 800V OR LESS Main service 100 AMP OR LESS 5.00 Main service EA. ADD'L 100 AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home ® Others ❑ Main service OVER 25.00 V AMPP OR LESS Main service EA. ADD'L 100 AMP 1.00 NEW CONST DWELING OR ADDNS. ( ACCLBLDGS.CCUP. &) 22sgft NEW CONSTR MULTI.OUTLET NON.RESID. ( BRANCH CIRCUITS) 2.50ea NEW CONSTR POWER APPARATUS & NON-RESID. SINGLE OUTLET CIR. CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: Ex. Occup(OUTLETS OR FIXTURES)92`C BAL�1 Ex. Occup ( FIXED APP LNS, OR • OUTLETS (RESID,) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License No. 4 7 / &, 4 1 .� Classification , Misc. Wiring 6.25 ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ MECHANICAL No. @ FEE 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 forWor men's Compensation. have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. F -1I 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 Q Heating Coo ling 5-0 )7V 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 $ authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. 7,►®ate Signature oof' Per itee 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 0 P BLIC WORKS By !' Date 6 —3 O— 77 Buiding permit expires Date ° ` 7