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Home My WebLink About078-270-017n - n _1 RAYMOND E. MARTIN 2336 OCA LA X k K 11 Wa OrnVilletax - Perm -it #633-7EP,E uti1.,MH , 4ELEC .3 /��710 /� S /--fd GAS 6111176 WA -1 SUPPORT STR_ UCTUR_E REQ. r1/,0 COMPACTION TEST REQ. AIC 5 Q Permit 3154-/76MHI ISSUED (� v(p'�_ %' V Permit #1376-77B,E(new'c&ana/MH) 1/%i7 a _Y o �. � � a f !. \ �. -- -- �. J� C� PE PERMIT NO. 1376-77B,E E(� PERMIT EXPIRES ��o "Oz/ OWNER Ray Martin z CONTR. owner LOCATION (A.P. 36=074-15 2336 Oak Knoll Way, Oroville Temp. Power Pole Called PG&E Temp. Elec. Serv. Cglled PG&E Temp. Gas Serv. Called PG&E JOB FINALED (Date) 'o (Sign ture) COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) PLUMBING Setback — Firewall Soil Piping Forms Parapets 1st Floor —Ae}n4WW cAsf't-l+- Restroom Finish 2nd Floor Footings Windows 3rd Floor / StemwalI Siding To out Slab Roof Sheathing Water Piping Piers— Roofing �. - Sewer G ra a Fdn. Vents Fixtures —ootin s Si•Pmwal I Garage Vents Insulation Water Htr. Heaters Slab Carport Footings Prov. for ph sically handica ed Conformance of ex. structure A llances Gas PI in & T t Temp. Gas Slati Final -;Z-- Sanitation Patio X FI EPLACE Final Footin s > Footing `, ELECTRICAL Masonry Walls Throat Rou h - % i Reinf. Steel Final Fixtures Bond Beam FI * SPRINKLERS Motors Framina % IT.., Water Htr. Stucco Final Subpanels /7 Mesh MECHANICAL Grd. Fault Prot. Scratch Heating Service Brown Cooling _ Temp. Pole Finish Ducts Underground Interior Lath Ventilation 41 Permanent Door Closer Final 71Final •MOBILEHOMEUTILITIES ------------------ Elec. Service Elec. Pedestal Water Piping Sewer Gas Piping MOSILEMOME INSTA L TI N - - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE ,/ REMARKS OR CORRECTIONS Pao 107j" -�, � �r oar colz-'VCk �1/11,117 7 e64�, ee- (NOTE: An entry must be made on this form each time you visit the job site.) V/ COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS 7 Cqunty Center Drive — Oroville, California 95965 ' TelephoVe: 534-x3541 &76_1-77 APPLICATION AND PERMIT A authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X Date $ g aturre of Permiiteee or Agent Receipt No. T! `7 3 C 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 B IC WORKS By Date Bildingermit expires Date y't -3' BUILDING OwnerRa V 11A SO. FT. OCC. BUILDING VALUATION 2 lf Mai IIng Address o 11 Tele hone No (o' Fireplace Contractor Total Valuation Mai I i ng Address LK) bt CP k4 Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee Building Address (C a4,4PLUMBING No. @ 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 r A. P. No. J? _ 0 — >J Zoning & Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 Fe W. Sa Ion Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA I Parking Parcel Plans Declar on Parcel Ma p 60' R/W Improvements p Lawn sprinkler system 2.00 Bldg. Plans Recd arcel Approval Plo pproval Permit Fee $ $ NEW ADDITION ❑ UTILITIES ❑ OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 0-0 Main service 100 AMP OR00V OR LE LESS5.00 Main service EA. ADD'L too AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home ® Others ❑ Main service OVER e O 25.00 100 AMP OR LESS Main service EA. ADD'L 100 AMP 1.00 /� NEW CONST. /DWELLING OC OR ADDNS. % ACC. BLDGS. 2C Sq it NEW CONST R. MULTI-OUTL T NON.RESID. ( BRANCH CIRCUITS) 2.50ea NEW CONSTR. (POWER APPARATUS .&) NON -RES ID. 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)92-1 BAL@1 00 FIXED APP LNS. OR Ex. Occup. (OUT LETS (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 $ 7.3 <0 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 $ 3 authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X Date $ g aturre of Permiiteee or Agent Receipt No. T! `7 3 C 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 B IC WORKS By Date Bildingermit expires Date y't -3' BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS SPECIAL INSPECTION REPORT Owner: lel4i�r!!O/�l� / %/% f\' A.P. # Address: o2 3 3 ,� 0 Tenant: Building Location: Type of Inspection requested: Date of Inspection 3 -/6 22 Inspector Housing / / 2. Financing 3. Change of Occupancy to ja 4. Other (specify) p;(J[. j DLIGcJIT�OcLT logx"yY/rS Present use of building: A. Sanitation (Housing) 1. Water closet: 2. Lavatory: 3. Bathtub or shower: 4. Kitchen sink: 5. Hot and cold water to fixtures: 6. Heating facilities:. 7. Natural light and ventilation: 8. Room and space requirements: 9. Bedroom window or door for second exit: 10. Infestation of insects, vermin, or rodents: 11. Connection to sewage disposal: 12. Connection to water supply: 13. Rubbish and garbage facilities: 14. Comments• B. Structural 1. Piers and footings: 2. Floor construction: 3. Wall construction: 4. Ceiling and roof construction: 5. Fireplaces: 6. Comments• C. Electrical 1. Service and ground: 2. Receptacles: 3. Fusing: 4. Comments: - D. Plumb in 1. Fixtures connected and vented: 2. Gas water heater: 3. Gas heating vents: 4. Comments: (continued on back) E. Other c 1. Maintenance and repair: 2. Fire hazards: 3. Safety hazards: 4. Weather protection: 5. Underfloor and attic ventilation: 6. Comments: F. Commercial Buildings 1. Roof covering: 2. Distance to property lines: 3. Physically handicapped: 4. Restroom floors and walls: 5. Exits: 6. Improvements: 7. Zoning: 8. Comments: G. Field Problems or Violations 1. Problem or violation (give complete description) :/!_��/i(/G- 2. 3. A. Information only - file. B. Hold for ten (10) days, then write letter. C. Write letter. D. Other: PERMIT NO. 63-3-76P,E PERMIT EXPIRES. Q� 11s11177 '6NER Raymond E. Martin CONTR. owner LOCA . TION (A.P. 36-074-15 "2336 Oak Know1l Way, Oraville fn TI to Temp. Power Pole -7 4 Called PG& T-emp.—Elec. rv- C - Called &E Temp. Ga Serv. Temp. Called a 'P E0 le w d e P c Power G Called I ed P Pole ry E Temp Ga Serv. - e ZIT Call d -PG&E /41 A/ I JO 0 F I L 76 I A L E /DJ 7(— t ) (Date) COUNTY OF BUTTE '— DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING I BUILDING (Cont'd) I 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-- li Piers Roofing Sewer 31—/ 7- 7L Garage Fdn. Vents Fixtures Footings Garage Vents Water Htr. Stemwall Slab Prov. for physically handicapped Heaters Appliances Carport Footings Conformance of ex. structure Gas Piping & Testes �7 L Temp. Gas Slab Final Sanitation Patio FIREPLACE Final Footings FFooting ELECTRICAL Masonry Walls Throat Rou h — Reinf. Steel Final I Fixtures Framing Test Water Htr. Stucco Final Subpanels Mesh MECHANICAL Grd. Fault Prot. Scratch Heating Service Brown Cooling Temp. Pole Finish Ducts Under round Interior Lath Ventilation Permanent Door Closer Final Final DATE REMARKS OR CORRECTIONS 1 � 7-7 G �} -< T� 3 e'l 47 \J A (NOTE: An entry must be made on this form each time you visit the job site.) 't COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE OROVILLE, 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', J h ll - 74 for the following location: 'Z 3 3 ( r)„/ k/.,_,,, // Owner— E Nf Owner's Address Z 3 3`/G /�/ iC!•�,,.,, // lrJ,r, Mobilehome Mfg. Model �� IIA74 -7 Year" -'9 Insignia No. Serial No. Z_�T It is hereby certified for occupancy at the above described location and may be occupied. Director of Public Works Date - 1 2- 7/_ By /r✓d �� / 1 THIS CERTIFICATE IS VOID WHEN MOBILEHOME ]S RELOCATED I .., ;. -,* . £i MOBIL EHOME INSTALLATION INSPECTION CHECK LIST 1 Is the mobilehome located with required separation from lot lines and buildings and generally conform to.plot plan? Yes !�o 2. Does the mobilehome have required clearances above ground? (Sec. 5085) Yeses No 3. Are footings and supports properly sized, spaced, and braced as ped^_ approved plans? (Note possible variation at spring shackles.) (Sec, 5082 & 5083) Yes No 4. Is the mobilehome level? (Sec. 5088) Yeso 5% If more than a sing unit, are crossover connections properly installed? (Sec. 5088) Yes No 'P� ° 6. Water A. Is flexible connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes No B: Test - Does water piping withstand working pressure or.50 lbs, air test? Yeses No C. Backflow - If coach is not State of Californiaproved, 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? Yesz--No B. Does it have minimum kit per foot slope and is -it properly supported? Yes---- No C. Are any leaks detected in drainage system after running 3 -gallons of water through each fixture including washing machine standpipe? Yes No D. If coach is not Stat of .California approved, does station have required trap and.vent? Yes No 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 mobilehome gas line inlet without reductions other than the mobilehome connector. Yes B. Test OK as per following procedure? Yes/o 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 411 appliance vents properly installed? YesNv o 9. Electrical A. Is service large enough to provide adequate amperage -to mobilehome (must equal rating of mobilehome with a minimum of 10 -amp) and other facilities on lot, i.e., water pumps, garage, cabana, etc.? Yes No B. Is there proper clearances around panels? Yes C. Is power supply cord or feeder assembly properly fused? Yes /'— No D. Is continuity. test satisfactory as per the following procedure? Yes 1. De -energize electrical wiring system of the mobilehome at the pedestal. 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. 4. Connect one lead of a test. instrument to the mobilehome grounding conductor and apply the other lead to each mobilehome supply conductor, including neutral. 5. All non-current., carrying metal parts of the mobilehome (aluminum siding, gas line, water line),• including fixtures and appliances, shall be tested for continuity from such equipment 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 test°s:hall then be made between the grounding electrode and the chassis of the mobilehome. Upon satisfactory completion of the electrical tests, the lot or site service equipment may be approved for energizing. 10. Is job carddrsigned by Health Department for water and sanitation? 11. If everything okay, sign off card and tag services. MOBILEHOME DATA / Manufacturer and/or Namestyle Length �a Width / L, Vehicle Serial No. State Identification No. ;9b Additional.Informati.on or Comments: COUNTY,OF BUTTE - DEPA-RTME,NT OF PUBLIC WORKS 7 County Center Drive — Uroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the abov e-mentioned property for inspection purposes. �� DateZA//2/�� Signature of Permitee or Agent Receipt No.� o 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 BLIC WORKS By Date wilding permit expires Date �- i -7 BUILDING Owner OA.JO Z:-, v77A-1 SQ. FT. OCC. BUILDING VALUATION Mailing Address 3 6 9 .P/X--Z-- 3L Telephone No. Cl c LC 5 33 "24?6 3, Fireplace Contractor Total Valuation , .11 Mailing Address W �``�±� Permit Fee Plan Checking Fee&/or Penalty Telephone No. Permit Fee $ Building Address .�3 ro O� A/ LL l�J4 PLUMBING No. @ FEE PERMIT FILING FEE $3.00 OU c L L 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. o. 6.— 6 7 — ),5- Zoning 8 Planning Gas piping system 1 - 5 outlets 1.50 Each additional outlet .30 F s W Mien- Fire Dept. Fire Zone Use Permit Building sewer 5.00 EQA Parking Plans Parcel Declaration parcel Ma P 60' R/W ►m provements Lawn sprinkler system 2.00 Bldg. Plan�'d I Parcel App Pla pproval Permit Fee $ $ NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER ® ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 ALL vT/o AJ o✓ Main service 100 AMP ORV OR LESS5.00 Main service EA. ADD'L loo AMP 2.50 SinSingle Family Duplex Mobil Home Others 9 Y ❑ P ❑ ❑ Main service OVER 600V loo AMP OR LESS 25.00 Main service EA. ADD•L 100 AMP 1.00 NEW OR ADDNST ( ADWECCLBLDGS.LING CCUP. &) 20syft NEW CONSTR. (MULTI -OUTLET NON.RESID. ( BRANCH CIRCUITS) 12.50ea NEW CON5TR. (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)50 @254: 104 Ex. Occu FIXED APPLNS. OR P. OUTLETS (RFIXED 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 /Cilpermit 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 it -- TOTAL PERMIT FEE $ 30 O authorize representatives of the County of Butte to enter upon the abov e-mentioned property for inspection purposes. �� DateZA//2/�� Signature of Permitee or Agent Receipt No.� o 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 BLIC WORKS By Date wilding permit expires Date �- i -7 BUTTE COUNTY DEPARnENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA. PHONE: 534-4541 MOBILEHOME INSTALLATION SHEET 1. Owner's name: 17A 7" 7 1 / 7K ✓ U IV .tom 4o- e s <y -f i f i .vim - �p 2. Installer's name: P L �oo-S 3. Is the site currently under permit? Yes No (If yes, furnish permit number ) 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 Wit. away from septic tank and leach fields and 5. 6. clear of all setbacks and easements? Yes No / ! (If no, clarify What is the mobilehome electrical rating? ---- ----------------- 1, Amps What is the mobilehome site service rating?-----------��^r"-'mow-"- APs s 7. What is the mobilehome site circuit breaker. rating? ---___-_.:_-_- 8. Is there any other electric load to be served by the mobil.ebome Amp s (This information not required if pipe length less than 6 ft. on natural gas or less than 50 ft. on LPG.) ------------------- Yes / No / siteservice? --------- -----------•-----------•- 7® (Amps) (If yes, identify the load and size:(Load) 9. What is the mobilehome site gas pipe size? ---------------------- 10. What is the type of gas service? ------------------------------ _ Natural / / LPG 11. What is the gas pipe length fror,.. metier or tank to the mobilehome? _ (ft.),, 12. What is the mobilehome gas demand.? -r ----------------------------- (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 - a h- Mobilehome Mfr. Setup Model No. Cc m Year T Width _(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). S.in lFootings-•(check.one, i, /i 1. Wood:either . pressure treated or C nter Center Support fdn.`grade.: S port Footing Sizes !! Lo at ions (in.) 2.:Concrete pad. x / / Other, -specify in. in. n. Supports (check one, 1. Concrete block (- -� x / / 2. Concrete piers -_ el piers 3. Ste p / i ....� ........ .. 4. Other, specify T El x� Typical Support x Footing Size .) (in.) i - D. Max. Pier... Spacing ft in.) in. BUTTE COUNTY (in.) (in.) + , j ,Overhang BUILDING nPRTMENI' , APPROVED *If center piers are other than drawn above,, draw in locations, spacing, and dimensions. _ c 2 —i COUNTY OF BUTTE - DILWARTMENT OF PUBLIC WORKS 7 County Center Drive — Oroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X stlDate L_?,/ -1-9 Signature of Permitee or Agent Receipt No.�� _-.7- 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 UBLIC WORKS BY Date i �- Iding permit expires Date Z BUILDING Owner (ea Lf A Q IQ � A � SQ. FT. OCC. BUILDING VALUATION / Mailing Address �p 3 69 A IMC z,4 A) Lvo, 1" � �O , Telephone No. 533— 6 c% Fireplace Contractor W E Total Valuation Mailing Address Permit Fee Plan Checking Fee &/or Penalty Telephone No. Permit Fee $ Building Address PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 3, o C> c AJ 6 L A Each Trap 1.50 Repair drainage or vent piping 1.50 Water piping 1-60 pip o `\ Each gas water heater or vent 1.50 A. P. No. oning Planning & Gas piping system 1 - 5 outlets 4-50 ® p Each additional outlet .30 es W.-C.S t' Fire Dept. FireZo ilding sewer v -&.60 p EQA Parking Parcel Declaration Parcel Ma P 60' R/W Im rovements P Lawn sprinkler system 2.00 y�Plans Bldg. Flans Rec'd Parcel Approval P Plan�rovol Permit Fee $ 33,00 $ 331,o4 NEW ❑ ADDITION ❑ UTILITIES OTHER ❑ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 3�6p Main service 100 AMP V OR ORSLESS ✓ 5.00 $ < fS Main service EA. ADD'L too AMP 2.50 Single Family ❑ Duplex ❑ Mobil Home Others ❑ OVR Main service 1100EAMP OR LESS 25.00 Main service EA. ADD'L too AMP 1.00 NEW OR ADDNST %[DWELLING % ACCBLGS.CCUP. &) 20sgft 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 St le of: Y Ex. Occup(OUTLETS OR FIXTURES)@� BALRI Ex. Occup. FIXED APPLNS. OR P• OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities ✓ 15.00 / p License No. Classification Misc. Wiring 6.25 01 am exempt from the Contractors License Laws of the State of California. Permit Fee $ _23-001$ a3 EC 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 fpermitis 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 1 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 $ cc authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X stlDate L_?,/ -1-9 Signature of Permitee or Agent Receipt No.�� _-.7- 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 UBLIC WORKS BY Date i �- Iding permit expires Date Z