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HomeMy WebLinkAbout079-120-022F SCHURKAMP�9- (iero'of/sf) HOLLAND, B.B. 3389B hill Dr 2714Pov it le 162-838 (install wostove/s') _, 331 E - t w 520 90B55 Fairhill Dr. , 'Lot 129, Copley Acres,} 0.. (new,' single-family) ? SCOFIELD, Dorothy' . n255*Fairhill Drive, Oroville f N } 1 1 4 a . Permit#3162-E3 Thomas Schurkamp '49 too"N 30gcddrL.r L- cl 4p Aosec.I47(--Es- U s 776— Fel 1Ztt4�� r- 9 i . ,E j a _ . COUNTY OF BUTJE, - QEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT PERMIT NO. ' l• IF ASSESSOR., PARCEL NUMBER ZONING BUILDING PERMIT , OWNER _ ` TELEPHONE SQ, FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER I' ! � - UNKNOWN Total Valuation $ 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 $ BUILDING ADDRESS PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar Water Heater 20.00 Water piping 5.00 LOT NO. SUBDIVISION NAMEPARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SFE1- Duplex❑ Mobilehome❑ Other SPECIFY Building sewer 5.00 Mobile Home I S1 GW 10.00 e TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑. Describe work: �" ' ' [`� ' ' J f Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LE55 10.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING OCCUP.& OR ADDNS. ACC. BLDGS. 21/20sgft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification [� 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 ULTI-OUTLET 2.50 ea NON.RESID BRANCH CIRC ITS NEW CONSTR. (POWER APPARATUS &' NON-RESID./ %SINGLE OUTLET CIR. Ex, OCCUp%OUTLETS OR FIXTURES 20@030 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 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. ❑ 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 shall be deemed revoked. Heating Cooling Hood 3.00 Ventilation Permit Fee $ Contractor 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 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 liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. X Date Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ ,- TOTAL PERMIT FEE $ at • �, OCCUP. GROUP I TYPE OF CONST. PARCEL PD I ND ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF PUBLIC By, fir' i� ! �) r PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date�� Receipt No. '7 't WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 ~j APPLICATION AND PERMIT PERMIT NO. (11,�7_ IY3 ASSESSOFP / NUM�E�.$•C/� •✓(1/O_ 1/V- ZONING BUILDING PERMIT OWN / M�9 S Sc/-/4q,"P TELEPHONE SQ. FT. OCC. BUILDING VAL AT ON OWNER'S MAILING _Ap%�SS p I e Q /�c CONE/TRACTOR'S NAJ)ME TELEPHONE CONTRACTOR'S MAILING ADDRE S Fireplace 0-p CONSTRUCTION LENUNKNOWN 16 Total Valuation $ Filing Fee $ 10.0 LENDER'S MAILING kDDRESS Permit Fee $ ARCHITECT OR ENGIN E LICENSE No. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILD[ reRESS..� r / w Z ✓C /%LrrJ.�f L UVVFr PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar Water Heater 20.00 Water piping 5.00 LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE SF ©Duplex ❑ Mobi lehome ❑ Other SPECIFY Building sewer 5.00 Mobile Home JSJGJWJ 10.00 e TYPE OF WORK New ❑ Addition ❑ RReemmodeI ❑ Uti lilies ❑ Installation4 Other Describe work: �A/ S/'�G� AJOd9 gulp// l� .5—tvVE Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING OCCUP.& OR ADONS. ( ACC. BLDGS. 2/20sgff CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification 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 U TI.OUTLET 2,50 ea NON.RESID BRANCH CIRC ITS NEW CONSTR.POWER APPARATUS &' NON.RESID. (SINGLE OUTLET CIR. 20Q50C Ex. Occup(o XTS OR FIXTURES BAL®30 FIXED APP LHS. OR Ex. Occup. OUTLETS (RESID.) EA.Jr 1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor MECHANICAL PERMIT Filing Fee 10.00 WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): Q The permit is for $100.00 (valuation) or less. ❑ 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. 1 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 shall be deemed revoked. Heating Cooling Hood 3.00 Ventilation Permit Fee $ Contractor 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 authorize representatives of the County of 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 liabilities, judgments, costs, and expenses which may in any way accrue ag 'nst s id County in coJe q nce of t e granting of this Gpermit. ` X Date `��7 �3 ' Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ Oslov OcCUP. GROUP I TYPE OF CONST. PARCEL' PD I NO ISSUE This permit is hereby issued under sion f the Butte County Code and/or wor i dicated above for which 1 CTQR OF PUBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date __ 9�/ Receipt No. / � WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - Department of Public Works 4` 7 County Center Drive, Oroville, CA. 95965 Phone: 916-534-4541 OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid'unnecessary delay in processing and issuing your build- ing permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed proper improvement (yes or no). 2 I (have/have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address. City Phone Contractors License No. 4. 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 Contractors License No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work iridicated: Name Address Phone Type of Work Signed: Property Owner .d , Social Security number Date NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND"PERMIT ASSESSOR PARCEL NUMBER' 36-61--22 -- ZONING BUILDING PERMIT OWNER R SCOFIELD -"— " TELEPHONE 589-3242 S0. FT. OCC. BUILDING VALUATION 25 s 1 S40 O NG ADDRESS 73 Montego Key novato CA 94949 CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation 1 $ 1,500 Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ 25.00 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 255 Fairhill Dr, Oroville Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO.SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF `Ji Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S F G W 10-00ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other ❑ Describe work: RAroof romp _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD -L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification Q 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) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason OR ADDNST ( DDWEACCLLI DGSCCUP.S.) 2yz¢sgft NEW CONSTR ULT' -OUTLET NON•RESID BRANCH CIRC ITS 2.50 ea POWER APPARATUS &) SINGLE OUTLET CIR. Ex. Occup OUTLETS OR FIXTURES 20@50t eAL030 FIXED \ Ex. OCCUp. OUTLETS (RESID.)REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ 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. F, 1 I shall not employ any person in any manner so as to become subject k=' 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 shall be deemed revoked. MECHANICAL PERMIT Filing Fee 10.00 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 County of 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 liabilities, judgments, costs, and expenses which may in any way accrue against s Id County_in.consequente of?the granting of this permit. �' -,��-f- �"'�% �� �' !� �/ X'o�i Date S'gnature of Appl'cant — Owner❑. Contractor ❑ Agent ❑r An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures oovverr'33 stoorries in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ HAz CUA PARK SCHL FLD PAR PD HD 'I-ISE This permit is nereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. R bTOJt F PUBLIC WORKS By 2 Date 4 PERMIT EXPIRES Date ^ �� / / Receipt No. -1 to Kq� WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT �ii� i, / i % '� r - COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. ems- -s�qp ASSESSOR PARCEL NUMBER 36-61-22 ZONING BUILDING PERMIT OWNER DOROTHY SG D TELEPHONE 589-3242 SQ. FT. OCC. BUILDING VALUATION 25 s 1,500 DWADDRESS 73 Montego Key novato CA 94949 CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ 1.500 Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ 25.00 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee Energy Plan Checking Fee A$ $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 255 Fairhill Dr Oroville Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SFOX Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S G W ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] Other ❑ Describe work: Reroof comp _ --10.00 Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Busines$ and Professions Code and my license is in full force and effect.SINGLE License No. Classification 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 oR ADDNSCONST. DWEACCLLING DGOCCUP,EI\ S./ 2'/20sq ft NEW CONSTR.ULT'-OUTLET NON-RESID BRANCH CIRC ITS 2,50 ea POWER APPARATUS e OUTLET CIR. Ex. Occu p OUTLETS OR FIXTURES z^L@ eL030 FIXED EX. Occup. OUTLETS PR RESID )EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. byirin 9 15.00 Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ 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. f41 I shall not employ any person in any manner so as to become subject Y� 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 shall be deemed revoked. Contractor MECHANICAL PERMIT FiIingFee 10.00 Heating Coolin g 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 County of 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 Iia 'lilies, judgments, costs, and expenses which may in any way accrue agai t Cou nsequeneA of the granting of this permit. X Data — S' natarre of App 'cant — Owner ❑ Contractor ❑ Agent ❑ n OSHA permit is required for excavations over 5'0" deep and demolition or construct- on of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ HAZ CUA PAflK SCHL FLo PAR PD HD I5 E Th;s permit is nereby issued under the applicable p9ovi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. R TO F PUBLIC WORKS BY Date Z Z3V PERMIT E PIKES Date Receipt No. � WNITC-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLD ENROD-APPLICANT COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541 OWNER -BUILDER VERIFICATION Attention Property Owner: An 'owner -builder" 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. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no) .fie . 2. I (have/have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone Contractors License No. 4. 1 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 Contractors License No. 5. 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 Signed:41 57 4 liZZ.` Property Owner Social Security Number Date � / NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831.and 19832 of the California Health and Safety Code. This verification must be completed and.returned to our office before we are per- mitted to issue the permit. COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER ZONING 60r 2i BUILDING PERMIT OWNERTIELEPHONE SC 0 Fl tr L 3Z�Z SO. FT. OCC. BUILDING VALUATION OWNER'S MAILI G ADDRESS 7 tic - &o 0 V4TD rA- L71P CONTRACTOR'S NAME TELEPHONE ' CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ - Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ 2 ARCHITECT OR ENGINEER LICENSE No. Plan Checking Fee $ Energy Plan Checking Fee ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ - PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water he er or vent 5.00 USE OF STRUCTURE SF Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 5 outlets 5.00 Building sewer 5.00 Mobile Home S 10.00eA! TYPE OF WORK New❑ Addition❑ Remodel❑ Utilities [I Installation❑ Other Describe work: El, 120a11,— �0/�� ! Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 100V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 I CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification ❑ 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 CONST. DWELLING 0CUP.L OR ADONS. ( ACC. BLDGS. 2httsgft NEW CONSTR. ULTI.OUTLET NON-RESID BRCH CIRCITS 2.50 ea POW" APPARATUS e\ (SINGE OUTLET CIR, / Ex. Occup(OUTLETS R FIXTURES zO@Sot SAL, 30t FIXED APP NS. OR Ex. Occup. oUTLETS (R sl D.1 EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑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 shall be deemed revoked. MECHANICAL PERMIT FiIingFee 10.00 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. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. X Date Signature of Applicant — Owner ❑ Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE TOTAL FEE $ ���- HAz cuA PARK SCHL FLD PAR PD HD ISSUE This permit is nereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS By Date PERMIT EXPIRES Date Receipt No. - WNITE-O-P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT