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RESIDENTIAL
PERMIT NO.
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SPECIAL
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SPECIAL CONDITIONS
CHECKED
BY
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
JOB FINALED (D G'
Signature
• COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERM T NO.
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSORffL (�{Ml1(�CHM
SL
ZONING
BUILDING PERMIT
OWNER
COMCAST
TELEPHONE
SO, FT, OCC. BUILDING VALUATION
°W"mss MVP ss DR SACRAMENTO Ca 95838
°°"r"WRSMAST COMMJNICATIONS
T343 2473
°°"° 140 MEY&S STREET CHICO CA 95928
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
Fireplace
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $ 20.00
Permit Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
9 OROVILLE LOCATIONS/ SEE ATTACHED
Energy Plan Checking Fee $
$
PERMIT FEE S
IAT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT Fling Fee 20.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other
SPECIFY
Each Trap 7.00
Solar or heat pump water heater 23.00
Water piping 15.00
Each gas water heater or vent 15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: PLACE CATV POWER SUPPLY
Gas piping stem 1 - 5 outlets 15.00
Building sewer 15.00
Mobile Home S G W @20.00
PERMIT FEE $
ELECTRICAL PERMIT Fling Fee 20.00
Main Service .0voR. 9 23.00 207.00
200A OR LESS
LICENSED CONTRACTOR'S 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 i in full force and effect R /—
License Class — Lic. No. 1 1L7 f5i (.
OWNER -BUILDER DECLARATION
hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ 1, 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.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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.
❑ I have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
Main Service TO 46.00
NEW CONST. DWEW
EE NG OCCUCUP.
OR ADDNS. ( a ACC. BIDS, 3.50xSONEW
CONST.:
NON-RESID. .=OUTLETCIRCUITS 1 @7.50
POWER APPARATUS
8 SINGLE OUTLET CIR.
Ex. Occup. OUTLET OR FIXTURES 20 C' ''50
BAL O .so
VEDI
Ex. OCCU 0"SA
5.00
Temporary Service 23.00
Mobile Home Facilities 2000.
Misc. Wiring23.00
PERMIT FEE $ 227.00
MECHANICAL PERMIT Fling Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEE $
Policy Number
(The above sections need not be completed If the permit is for work of a valuation
of one hundred dollars ($100) or less.)
❑ 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 workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation pro ' ions of section 3700 of the Labor Code, I shall
forthwit cc plywft tho a isions.
X Date (t ' Z '
Signature of Applicant - ❑ Owner Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or constructionAJJU
of structures over 3 stories in height
Mobile Home Installation Fee $
Energy Inspection Fee $
OCC
CONST. TYPE
TOTAL FEE $ 227.00
HAZ.
D. FEES IMP
I FLOOD
I CDF
PARCEL
I PD
HD
ISSUE
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated ova for which fees have been paid.
By Qjite'v/ lqlo
PERMIT EXPIRES O
ate
Receipt No. '�
WHITE-D.D.S.-B.D. CANARY -ASSESS R PI -INS ECTOR GOLDENROD -APPLICANT
OROVILLE POWER SUPPLY STATUS 10127/2003
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28 OROVILLE OR1 4 Pol NO AER COUNTY PG&E 036-630-009 16 FAIRHILL OR
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29 OROVILLE OR15 P02 NO AER COUNTY PG&E 036-340.013 12MOROVILLE GARDEN RANCH RD
30
OROVILLE
OR17
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PG&E
068-350-015
3948 HILLDALE AVE
:
33 OROVILLE OR17 P02 NO AER COUNTY PG&E 068343015 4742 HILLDALE AVE
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