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S � BEASLE Y H . K .
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3627 Greenbank Avenue,
' Oroville -----�
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S � BEASLE Y H . K .
955. r
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3627 Greenbank Avenue,
' Oroville -----�
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bU I It L;UUIV I Y'
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541
FLKIVil 1 IVU.
BPO50631
B. C. Building Permit Ul-16-04 pg 1
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of
the Business and Professions Code, and my license is in full force and
Issued Date: 03/08/2005 APN: 036-420-029-000
effect.
License Class : License Number:
Site Address: 193 MOUNTAIN VIEW DR ORO
Dale: Contractor: -
Map Index:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Description: REROOF 33SQ
Contractors' Slate License Law for the following reason (Sec. 7031.5
Business and Professions Code: Any city or county which requires a
permit to construct, alter, Improve, demolish, or repair any structure, prior
to its issuance, also requires the applicant for such permit to rile a
Owner: SWEENEY PAULINE O
signed statement that he or she is licensed pursuant to the provisions of
193 MOUNTAIN VIEW
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
she is exempt therefrom and the basis for the alleged exemption. Any
95966
violation of Section 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
Code: The Contractors' State License Law does not apply to an
owner of property who builds or Improves thereon, and who does
Applicant: SWEENEY PAULINE O
such work himself or herself or through his or her own employees,
193 MOUNTAIN VIEW
provided that such improvements are not Intended or offered for
OROVILLE, CA
sale. if however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
95966
proving that he or she did not build or Improve for the purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code. The Contractors' Slate License Law does
not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed
Contractor:
pursuant to the Contractors' Stale License Law.).
❑ I am Exempt under Article 3 of th%Business and Profe pions ode
4S l
Date: Owner:
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declarations:
License #:
❑ 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
is issued.
Architect:
❑ I have and will maintain workers' compensation insurance, as
required by Section 3700 the Labor Code, for the performance of
Engineer:
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 #:
Valuation: $0.00
1 certify that in the performance of the work for which this permit is
Census Code:
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 comply with those provisions.
Dale:
Applicant:
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars (8100,000), in addition to the cost of.,
compensation, damages as provided for in Section 3706 of the Labor
/
`—TQC G(
code, interest, and attorney's fees.
}•(/ ( —/v
CONSTRUCTION LENDING AGENCY
This perm' is hereby1fisued under the applicable provisions of the Butte County Code and/or
Resolulio to o indicated abo for vrM"ch fees have been paid.
I hereby affirm that there is a construction lending agency for the
s
performance of the work for which this permit is issued (Sec 3097 Civ.)
Date:
Name:
By
PERMIT EXPIRES
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.
❑ Notification in accordance with Section 19627.5 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 a ree 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 Cou . I hereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.
i
Priht Name: eC//C.ei4•.,m AE� 2,c-- Signature:
Date:
O Owner EI Contractor Agent for Owner ❑ Agent for Contractor
B. C. Building Permit Ul-16-04 pg 1
4
BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT APPLICATION
AND SUBMITTAL REQUIREMENTS
24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
OFFICE #: (530) 538-7541
A FEE WILL BE REQUIRED AT TIME OF APPLICATION
Website: www.buttecounty.net/dds
"PLEASE PRINT CLEARLY"
OWNER
Last Name n
First Name
Address
City v�/tGG�
StateW,
Zip?s5.5p
Phone � �
Fax
E-mail
-ARCHITECT/ENGINEER
CONTRACTOR
Name
City.
Address
Zip
City
Fax
State
Zip
Phone
E-mail
Fax
E-mail
Planner
Lic. #
Class
-ARCHITECT/ENGINEER
Name
Address
City.
State
Zip
Phone _
Fax
E-mail
State License Number
APPLICANT NAME
Name
AP#
Address
6n t/4
City VtGe G
65 Anc
State
,
Zip
Phone.
Fax
Type Const.
Subdivision Name
E-mail
APPLICANT SIGNATURE
X
For office use only:
Zoning
AP#
Flood Zone
Property AddressCity
SRA
I Yes
I No
Occ.
Type Const.
Subdivision Name
Map Book
Page
Lot #
Planner
Date Approved:
PERMIT
t1
1'k_, ..
BIN #
Description or Scope of-Worf� m
VU
Sq. Footage -
❑ Structure Built without Per s
❑ Proposed Change of Occupancy
(Note previous use):
OVER FOR SUBMITTAL KhUUIKtMtN I s
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2
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:
Receipt #:
1
Date: :_�? ( uI 0 --
Amount: ! ��` U Bldg
SRA
Sheriff
SMIP
Other
b ) Total
REV 7-27-04
LOCATION
AP#
Property AddressCity
s GLC1
d UtLC.
Cross Street
WORKER'S COMPENSATION
Policy Number
Carrier
If hiring anyone other than license contractors, a certificate of worker's
compensation must be shown at the time of permit issuance.
LENDING AGENCY
Name
Address
Description or Scope of-Worf� m
VU
Sq. Footage -
❑ Structure Built without Per s
❑ Proposed Change of Occupancy
(Note previous use):
OVER FOR SUBMITTAL KhUUIKtMtN I s
K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2
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:
Receipt #:
1
Date: :_�? ( uI 0 --
Amount: ! ��` U Bldg
SRA
Sheriff
SMIP
Other
b ) Total
REV 7-27-04
41 1
SUBMITTAL & PERMIT REQUIREMENTS
The following drawings and specifications must be submitted to the Building Division in order to apply for a
permit.
INCOMPLETE SUBMITTALS WILL NOT BE ACCEPTED. ALL PLANS MUST BE LEGIBLE AND IN INK.
❑
1.
Site plans, 3 or 4 sets, signed by the preparer of the plans. No graph paper!
❑
2.
Complete plans, 3 or 4 sets, signed by the preparer of the plans (No graph paper!) OR
Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations.
[�
3.
Engineered truss details and layouts in duplicate (if required). No faxes!
❑
4.
Energy compliance design and supporting documentation in duplicate. (Note: Not required for additions to
mobile or modular homes.)
❑
5.
Statement of Intent for Non -heated and AIC for Non -Residential Buildings.
❑
6.
Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down
or fnd plans, all in duplicate.
❑
7.
Metal bldgs: (A) Metal Bldg Plans, (B) Fnd plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor
plans in triplicate. All of these must be stamped and wet -signed by the engineer.
❑
8.
Flood Elevation Certificate, wet -stamped and signed, in duplicate (if required).
❑
9.
Site plan and business license approval from the City of Biggs.
❑
10.
Letter of intent for non-residential buildings.
❑
11.
Detached Accessory Building Form filled out by the owner (if required).
❑
12.
Hazardous Material Form (for Commercial Buildings only).
❑
13.
Sanitation and site plan approval from the Environmental Health Department.
Remaining items needed to issue the permit. Additional items may be required after Plan Check and Planning
review
(May require additional plan review upon receipt of the following items.)
❑
1.
Agricultural Buffer clearance and site plan approval from the Ag Commissioner's office (if required).
❑
2.
Impact Fees.
❑
3.
California Department of Forestry plan approval (if required).
❑
4.
NPDES Form.
❑
5.
Encroachment Permit for driveway from the Public Works Dept. (construction approval prior -to occupancy).
❑
6.
Contractor's license information. (Number, Name Style, Classification):_
❑
7.
Worker's Compensation Carrier and Policy Number.
❑
8.
Owner -Builder Verification (if required).
❑
9.
Letter of Signature authorization (if required).
❑
10.
Recorded copy of Agricultural Acknowledgment Statement.
❑
11.
❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner (for 433A's).
If you have questions or would like additional information regarding this process, contact a Permit
Application Assistant at (530)538-7541.
EXPIRATION OF APPLICATION
Applications for which a permit has not been issued will expire one year after date of application. In order to renew action
on an application after expiration, a new application, plans and fees will be required.
REQUEST FOR FEE REFUNDS
Refunds can only be made upon written request by the person who paid the fee. The request must be made within two
years from the date of fee payment on permits not issued, and two years from the date of permit issuance for permits
issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan
check fees for work plan checked and other department costs are not refundable.
OVER FOR BUILDING PERMIT APPLICATION
KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 REV 7-27-04
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PERMIT NO. 20—$2B
PERMIT EXPIRES1 /5.15.3 _
OWNER PAULINE SWEENEY
CONTR. Quality Construction
ASSESSOR PARCEL 36-42-29
L"
LOCATION 193 Mountain View, 0 OVille
d
1
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k'
1
l
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i
1
a
r Temp. Power Pole
Called PG&E
Temp. Elec. Service
Called PG&E
Temp. Gas Service
Cal led PG&E
%/00,
JOB FINALED (Date) `� C� �/
Signature
5
a..
J = OK
(y 9 Not OK
= Not Applicable
= Not Ready
MOBILEHOMES
MISCELLANEOUS
Date
MOBILEHOME UTILITIES (Plans) OK except N's
1. Zoning Requirements -Setbacks -Easements
Date
DECKS, COVERS, CARPORTS, ETC. (Plans) ut, oxcept
1. 'Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support -Sketch
3. Sewer; Location -Test -Fall -C/0 -Concrete
_
2. Footings; Size -Depth -Spacing -Connectors
3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
4. Water; Location -Test -Easement Needed (Sketch)
5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete
4, Wood Awn.; Posts-Beams-Rftrs.-Connec.-Shthg.-Rfg.-Bracing
5. Alum. Awn.; Columns-Connections-Splice-Decal-Encosures
6. Gas; Location -Test -Wrap:/ /"L"ft./ /"Nat. or/ /"L"ft./ /"LPG
6. Carports; Windows -Doors
7. Utility Clearance
7. Elec.
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date
Date Card -BI Date
MOBILEHOME INSTALLATION (Plans) OK except N's
Card -BI
Date
_
Date Card -BI Date
POOLS (Plans) OK except k's
1, Zoning Requirements -Setbacks -Easements
1. Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
2. Soils; Compaction -Structure Stability
3. Gas; MH Test -Demand -Valve -Connector
3. Pool Structure; Steel -Connections -Thickness -Dead Men- Lining
4. Electricity; MH Test -Crossovers -Breakers -Clearances
4, Elec.; Receptacles and Lighting; Distances-GFI
5. Drain; MH Test -Fall -Flex Connector
5. Elec.; Pool Lighting; 15 volts-GFI
6. Water; MH Test -Regulator -Connector
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Water and Sewer Connected -C/0 to Grade -HD Approval
7. Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater
8. Gas and Electricity Tagged
8. Elec.; Grounding; Equip, w/5' -Circulating Equip. -Pool Lghtg.
Boxes -Enc losures-Panelboards-Ins. to Main in Conduit
9. Exits; Insp.-Sketch
10. Cert. of Occupancy
9. Health Department Approval
10. Plumb; Cir. Test -Water Supply Test
Card B -I
Date Card -BI Date
Card -BI
Date Card -BI Date
Card B-1
Date Card -BI Date
Card -BI
Date Card -BI Date
L
= OK
= Not OK
= Not Applicable RESIDENTIAL (Single and Duplex)
= Not Ready
Date
UNDERFLOOR Plans OK except #'s
Date
FRAMING (Continued)
1. Zoning requirements -Setbacks -Easements
48.
Property Line Firewall & Openings
2.
Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth
49.
Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
3.
Fig., Garage; Soils -Steel- / /" Ftg. Depth
50.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
4.
Fig., Porches & Decks; Soils -Steel- / /" Ftg. Depth
51.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab
52.
Siding -Nailing -Veneer
6. Stemwalls, Garage; Steel-61ockouts-Wrapped-Slab
53.
Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access
7.
Piers -Fireplace Ftg.-Steel
54.
Glazing Area -Glass Protection -Skylights -Plastic
8. D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test
9. Gas Pipe; Size -Anchors
55.
Shear Walls; Nailing -Bolts
10.
Water Pipe; Test -Anchors -Regulator -Service Test
11.
Electric; Underground
12. Plenums & Ducts; Clearance -Material -Support -Ins.
13.
Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date
Date Card -BI Date
FINAL (Plans) OK except q's
56. Ext. Steps -Door & Sidelight Protection -Landings
Card -BI
Date
_
Date Card -BI Date
PLUMBING (Permit) OK except q's
14. Water Ht.; Vent -Access -Combustion Air
57.
Smoke Detector
58.
Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
15. Water Pipe; Test & Anchors -Nail Protection
16.
D.W.V.; Test-Fttngs & Anchors -Nail Protection
59.
Bedroom Exiting
17.
Shower Pan; Test, First Floor -Tub Access
60.
G.F.I. & Bath Fixtures & Tub Access
18.
Test Tub & Shower, 2nd Floor -Tub Access
61.
Elec. Trim & Subpanel; Breaker Sizes -Labels
19.
Gas Pipe; Size & Anchors
62.
Stairs & Rails
" --
63.
Fireplace or Stove; Clearances -Hearth
Card -BI
Date Card -BI Date
64.
Elec. Outlets at Wood Panel; Int. & Ext.
65.
Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
Card -BI
Date Card -BI Date
66.
Elec. Outlets & Receptacles at Kit. Counter
Date
ELECTRICAL Permit OK except q's
67.
Garage Fire Door; Swing -Landing -Closer
68.
A.C. Duct in Garage -Damper
20.
Fixture & Transformer Clearance -Ins. Protection
69.
Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor-Mech. Protection
21.
Elec. Receptacles Spacing -Lights &Switches at Doors
70.
Plb., Elec. & Mech. Equip. Listed for Location
22.
Size Boxes & No. of Conductors -Stapled
71.
Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
23. Romex Installed Close to Edge of Studs & C.J.
_
24.
25.
Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water
2 Appliance Circuits in Kitchen &Conductor Size
72•
Insulation -Foam -Looked in Attic ❑ Yes
73.
Guard Rails & Deck Construction -Post Caps
74.
Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance
Looked under Floor ❑ Yes
-_
26. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al
27.
Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al,
Insulated Neutral []Yes ❑No
75.
Following instld.: Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No;
Planters []Yes 0 N
28.
Service -Riser Conductors & Ground -Main Disconnect
76.
Stucco; Brown -Finish
29.
30.
Equip. Clearances; Panels-Motors-Mech. Equip.
Clothes Closet Light -Shower Light
77,
A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet
78.
Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs.
--
79.
Water Well; Disconnect, Electrical, Plumbing
---
--
80.
Exterior Elec. Trim; G.F.I. Receptacle -Underground
Card B-1
Date Card -BI Date
81.
Ventilation throughout House
Card B -I
Date Card -BI Date
82.
Glass Protection
Date
MECHANICAL (Permit) OK except N's
31. _A.C. Ducts; Insulation & Support
83.
_
Corrections from Previous Inspections
84.
Gas Test -Meters Tagged; Gas -Electric
85.
Water & Sewer Connected -C/O to Grade -HD Approval
_
____33.
_32.
Vent Fan; Exhaust above Insulation
Condensate Drain & Overflow; Size & Grade
86,
Energy Compliance Certificate -Other Certificates
34.
Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet
35.
Attic Access .-& Platform if Furnace in Attic
Card -BI
Card -BI
--
---
- - --- - - -- -- ----
Date - - _Card -BI - Date
Date Card -BI Date
Card -BI
Card -BI
Date Card -BI Date
Date Card -BI Date
Card -BI
Date Card -BI Date
Date
FRAMING(Plans) OK except p's
36. Sills; Proper Material &Anchors
37. _Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound
36.
38. Bearing Walls over Girders & Floor Nailing---
39. Draft Stop in Walls (rat proof)
Comments at Final:
-
40.
Fire Stops; Furred Ceilings -Stairs -Chases -Tub
41.
42.
43.
44.
er & Beam -Size & Bearing
Head - "
- "-- - -
Hangers -Post Caps -Anchors -Connectors
Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng.
Fireplace Ties or Type A Flue -Fireplace Throat
45.
46.
47.
Attic Access: Size & Romex Protection -Draft Stop -Ins. Baffles _
Bdrm. Windows or Exiting Doors -Sill Hgt. &_Dimensions _
Garage Fire Protection Framing
(NOTE: Anentry must be made each time you visit job site)
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone 916/534 1 ^^D Ba
•` APPLICATION AND PERMIT c�
A SS ESSO PA CEL NUMBER
<3� -a 9
ZONING _
BUILDING PERMIT
OW
yal)` �
TELEPHONE
b1�
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAIAG A RtE;SSENT
3cQV ICS
—
CONMACTOR'AME TELEPHONE
is�'-�u
CONTR—
ACTOR'S MAILING A�DRESio
Fire lace
p
CONSTRUCTION LENDER
UNKNOWN
Total Valuation Is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$ 30,10a
BUILDING ADDRESS
19=3 Ab Q 1V1
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
1 2.00
Repair drainage or vent piping
5.00
r -p
Water piping
LOT NO.
SUBDIVISION NAMEPARCEL
MAP
Each qas water heater or vent
5.00
Gas piping system 1 - 5 outlets
USE OF STRUCTURE
SF Duplex ❑ Mobi lehome ❑ Other
SPECIFY
Building sewer
Lawn sprinkler system
5.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ ti lities Instal lation ❑ Other
Describe work: We s cl
��.� —
b44100
Permit Fee
$
Contractor
o ELECTRICAL PERMIT
Filing Fee 10.00
Main service 600V OR LESS
AMP OR LESS
5.00
�
6 V
,'I"
Main service EA. ADD'L 100 AMP
2;50
NEW CONST. /DWELLING OCCUP.&)
OR ADDNS. \ ACC. SLOGS.
22 sq ft
CONT ACTORS LICENSE LAW
nder penalty of perjury
p y p I y (check one):
I d);�nd
am licensed under provisions of Chapt. 9, Div. 3 of the Business
Professions Code and my license is in full force and effect.
License No. 3542 / Classification 6
❑ I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONSTR. MULTI -OUTLET 2.50 ea
NO N.RESID BRANCH CIRC Ts
NEW CONSTR (POWER APPARATUS S1
NON-RESID. (POWER
OUTLET CIR. /
Ex. Occup OUTLETS OR FIXTURES a ��
FIXED APPLNS. OR
Ex. Occup.(OUTLE TS (RESID.) EA. 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 7.50
Permit Fee $
Contractor
MECHANICAL PERMIT
FiIingFee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
pt!;.,i have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to. Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shal I be deemed revoked.
Heating
Cooling
Hood
3.00
Ventilation
permit Fee
$
Contractor
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 Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabili 'es, judgments, costs, and expenses which may in any way accrue
against s 'd Co y in ouence of the granting of this permit.
�+..-. 5- -
X Date
Agent ❑
Signature of Applicant — Owner ❑. ContractoNO-
An OSHA permit is required for excavations over 5eep and demolition or construct-
ion of structures oovverr93rs7tories in height.
Mobile Home Installation Fee .
$
TOTAL PERMIT FEE $
OCCUP. GROUP
I TYPE OF CONST.
PARCEL
PD
HD
IssuE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
IR CTpr OF PUBLIC•WORKS
By
PERMIT EXPIRES to , —��
the applicable provi-
resolutions to do
fees have been paid.
Date 1_25 9 Z
C 1 .-1
Receipt No. �"l / 43
WHITE-D.P.W., YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT