HomeMy WebLinkAbout079-190-0650
DIANNE McKEEHAN
9 Regent Luop, Oroville -7 c
Contr: Jace Rash
Permit#3710-87B,
04-3599
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L4 DIANNE
MCYE14A],
9 REGENT LOOP �OVILLE
Cont*.,,vEBSTEP' �0-pLECTRIC
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BUTTE COUNTY
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING PERMIT
24 HOUR INSPECTION #: (530) 538-7636 (OROVIL'LE) (530) 891-2834 (CHICO)
OFFICE #: (530) 538-7541 FAM (530)538-2140
WFR QITt w hiaMarnunfu naArldc
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
effect.
License Class : G / License Number: Gr�^yyL
Date: Z Z 6 Contractor: �i=dam/Gv y �CG�
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors' State 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 file a
signed statement that he or she is licensed pursuant to the provisions of
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
she is exempt therefrom and the basis for the alleged exemption. Any
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
such work himself or herself or through his or her own employees,
provided that such improvements are not intended or offered for
sale. If however, the building or improvements are sold within one
year of completion, the owner -builder will have the burden of
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' State 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
pursuant to the Contractors' State License Law.).
❑ 'I am Exempt under Article 3 of the Business and Professions Code
Date: Owner:
WORKERS' COMPENSATION DECLARATION
I 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 the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier:
Policy #:
PERMIT NO.
BP043589
Issued Date: 12/21/2004 APN: 036-580-023-000
Site Address: 9 REGENT LOOP ORO
Map Index:
Description: UP-GRADE/REPLACE TO NEW
ELECT.SERVICE 100 AMP
Owner: MCKEEHAN DIANNE KAYE
9 REGENT LOOP
OROVILLE, CA
95966
Applicant: MCKEEHAN DIANNE KAYE
Contractor: WEBSTER ELECTRIC
363 CANYON HIGHLANDS
95966
530-533-8522
License #: 366446
Architect:
Engineer:
Total Square Ft:
Valuation:
01- I 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.
Date: _f ;a AA
Applicant:
WARNING: Failure to secure workers' compensation coverage is
unlawful, and shall subject an employer to criminal penalties and one
hundred thousand dollars ($100,000), in addition to the cost of
compensation, damages as provided for in Section 3706 of the Labor
code, interest, and attorney's fees.
0 S. F.
$0.00
�P�h'�892
CONSTRUCTION LENDING AGENCYThis permit is hereby'ssued under the
I hereby affirm that there is a construction lending agency for the Resolution to do w • indicated abov
performance of the work for which this permit is issued (Sec 3097 Civ.)
Name: By:
Address:
PERMIT EXPIRES ON
isions of the Butte County Code and/or
have been paid.
Date:
❑ I hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safely Code, which regulate the storage,
handling and use of hazardous materials.
❑ Notification in accordance with Section 19827.5 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 l am the owner or the duly authorized agent of the owner. I agree 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 County. thereby
authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes.
Print Name: _t/ Cf Oy7 t I �i!%�S �GV 'Signature:
Date:
❑ Owner 0-6ntractor 0 Agent for Owner
❑ Agent for Contractor
/VY'%"F'`-'^ BUTTE COUNTY
/ 0 0 DEPARTMENT OF DEVELOPMENT SERVICES
0 0 BUILDING PERMIT APPLICATION
0 0 AND SUBMITTAL REQUIREMENTS
- - 0 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834
p = p OFFICE #: (530) 538-7541
�► y A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION
00 N� Website: www.buttecounty.neUdds
-- "PLEASE PRINT CLEARLY"
OWNER
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Address ;70, dv�
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Fax
E-mail
APPLICANT NAME
CONTRACTOR
Name
City
Address
Zip
City
StateG,,
Zips y�
Phone S- ' 3 :�
�� 2-
Fax
E-mail
Planner
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clasp157
APPLICANT NAME
ARCHITECT/ENGINEER
Name
City
Address
Zip
City
Fax
State
Zip
Phone
Book
Fax
E-mail
Planner
State License Number
APPLICANT NAME
Name
Address
City
State
Zip
Phone
Fax
E-mail
APPLICANT SIGNATURE
X
For office use only:
Zoning
Property Address
Flood Zone
Cross Street
SRA
Yes
No
Occ.
Type Const.
Subdivision Name Map
Book
Page
Lot #
Planner
Date Approved:
PERMIT
0/_ 651�_q
BP
BIN #
LOCATION
AN / _ � ^ Z
( CJ
Property Address
City
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 Work:
G C-- ze- /e-,--
Sq. rootage
0 Structure Built without Permits '
O Proposed Change of Occupancy
(Note previous use):
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.
OVER FOR SUBMITTAL Kl=QIJIKLMtN 15
K:\FORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 1 of 2
Received by: Amount: t Bldg
SRA
Receipt #: 11 V Sheriff
CSMIP
Other
N I:::,- ca
Total
REV 7-27-04
SUBMITTAL & PERMIT REQUIREMENTS
The following drawings and specifications must be submitted to,the Building Division in order to appy 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 A/C 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 PI'an's,'(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. l
❑ 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 th6�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 requir'ed).
❑ 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 Ipermit 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. -I
OVER FOR BUILDING PERMIT APPLICATION
KAFORMS\BUILDING F0RMS\B1dgApp1SubRgmts.doc Page 2 of 2 I REV 7-27-04
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PERMIT NO:. 3710-87B,E
PERMIT EXPIRES
OWNER DIANE McKEEHAN
CONTR. JAce Rash
36-58-23
ASSESSOR PARCEL
4
LOCATION 9 Regent Loop, ORoville
r
t
R
Temp. Power Pole
Called PG&E
Temp. Elec. Se
Called PGI
Temp. Gas Ser
l•
Called PG!
JOS FINALED
Signature
f
= OK
0=Not OK
' a Yable MOBILE HOMES MISCELLANEOUS
= Not Ready
Date
MOBILE HOME UTILITIES (Plans) OK except #'s
Date
DECKS,COVERS,CARPORTS,GARAGES, (Plans)O exce C`a#'s
1. Zoning Requirements -Setbacks -Easements
1. Zoning Requirements -Setbacks -Easements
2. otings; Soils -Size -Depth -Spacing -Connectors -Steel
2. Soils; Special MH Support -Sketch
3. Sewer; Location -Test -Fall -C/O -Concrete
3. Joists -Decking -Bracing -Stairs -Rails
4. Water; Location -Test -Easement Needed (Sketch)
4-Weed--Aanr—Pests=Beams-Rftrs.-Connec.-
hthg.-Rfg.-Bracing
5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete
6. Gas; Location -Test -Wrap: / /"L"ft.
/ /"Nat. or/ /"L"ft./ /"LPG
5. onnections-Splice-Decal-Enclosures
7. Utility Clearance
ecc. Kb V
Fr Sills -An ors- tuds- ftrs-Trusses
)_-D ,
Siding; Nailing -Veneer -Stucco -Mesh
Card -131
Date Card -131 Date
,x//10.
2--;YG,
Roof; Shthg-Roofing
1. Ext.; Steps -Doors -Landings
Card -61 Date . Card -131 Date.
Date
MOBILEHOME INSTALLATION (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
Card -131
Date C rd -131 Data a---3.-
2. Footings; Size -Spacing -Marriage Line
Card -131
Date Card -131 Date
3. Gas; MH Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
Date
POOLS (Plans) OK except #'s
5. Drain; MH Test -Fall -Flex Connector
1. Setbacks -Easements
6. Water; MH Test -Regulator -Connector
2. Soils; Compaction -Structure Stability
7. Water and Sewer. Connected -C/O to Grade -HD Approval
3. Pool Structure; Steel -Connections -Thickness -
Dead Men -Lining
8.. Gas and Electricity Tagged
9. Exits; Insp.-Sketch
4. Elec.; Receptacles and Lighting, Distances-GFI
10. Cert. of Occupancy
5. Elec.; Pool Lighting; 15 volts-GFI
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
Card -131
Date Card -81. _ Date
8. Elec.; Grounding; Equip. w/5' -circulating Equip. -Pool Lghtg.
Boxes-Enclosures-Panelboards-Ins. to Main in Conduit
Card -131
Date Card -81 Date
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
Card -131
Date Card -131 Date
Card -B1
Date Card -131 Date
✓= OK
0=Not OK
'- = Not Applicable
= Not Ready
RESIDENTIAL (Single and Duplex)
UNDERFLOOR (Plans) OK except #'s
1. Zoning requirements -Setbacks -Easements
2. Ftg., Main; Soils-Steel-Elec. Grnd.-/ /" Ftg. De
3. Ftg., Garage; Soils -Steel-/ P' Ftg. Depth
4. Ftg., Porches & Decks; Soils -Steel-/ /"Ftg. De
5. Stemwalls, Main; Steel-Blockouts-Wrapped
6. Stemwalls, Garage; Steel-Blockouts-Wrapped
7. Slab; Steel -Wrapped
8. Piers -Fireplace Ftg.-Steel
9. D.W.V.; Fall -Fittings -Test -2 way C/O -Sewer Test
10. Gas Pipe; Size -Anchors
11. Water Pipe; Test -Anchors -Regulator -Service Test
12. Electric; Underground
13. Plenums & Ducts; Clearance-Material-Supprt-Ins.
14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
15. Insulation
Card -B1 Date Card -131 Date
Card -131 Date Card -81 Date
Date PLUMBING (Permit) OK except #'s
16. Water Ht. Vent -Access -Combustion Air
17. Water Pipe; Test & Anchors -Nail Protection
18. D.W.V.; Test-Fttngs & Anchors -Nail Protection
19. Shower Pan; Test, First Floor -Tub Access
20. Test Tub & Shower, 2nd Floor -Tub Access
21. Gas Pipe; Size & Anchors
Card -61 Date Card -81 Date
Card -131 Date Card -131 Date
Date ELECTRICAL (Permit) OK except #'s
22. Fixture & Transformer Clearance -Ins. Protection
23. Elec. Receptacles Spacing -Lights & Switches at Doors
24. Size Boxes & No. of Conductors -Stapled
25. Romex Installed Close to Edge of Studs & C.J.
26. Equip. Ground made up w/Mach. Fasteners -Bond Gas & Water
27. 2 Appliance Circuits in Kitchen & Conductor Size
28. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / /ga.
Cu or Al
29. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al.
Insulated Neutral Yes No
30. Service -Riser Conductors & Ground -Main Disconnect
31. Equip. Clearances Panels-Motors-Mech. Equip.
32. Clothes Closet Light -Shower Light -Spa Light
Card -131 Date Card -131 Date
Card -61 Date Card -131 Date
Date MECHANICAL (Permit) OK except #'s
33. A.C. Ducts Insulation & Support
34. Vent Fan; Exhaust above insulation
35. Condensate Drain & Overflow; Size & Grade
36. Furnace -Vent; Access -Comb. Air -Return Air Vent -115 outlet
37. Attic Access & Platform if Furnace in Attic
Card -131 Date Card -131 Date
Card -131 Date Card -131 Date
Date FRAMING (Plans) OK except #'s
38. Sills, Proper Material & Anchors
39. Walls Studs -Nailing, Spacing & Bracing -Plates -Sound
40. Bearing Walls over Girders & Floor Nailing
41. Draft Stop in Walls (rat proof)
42. Fire Stops; Furred Ceilings -Stairs -Chases -Tub
43. Header & Beam -Size & Bearing
Date FRAMING (Continued)
44. Hangers -Post Caps -Anchors -Connectors
45. Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng.
46. Fireplace Ties or Type A Flue -Fireplace Throat
47. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
48. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions
49. Garage Fire Protection Framing
50. Property Line Firewall & Openings
51. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
52. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
53. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
54. Siding -Nailing Veneer
55. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access
56. Glazing Area -Glass Protection -Skylights -Plastic
57. Shear Walls; Nailing -Bolts
58. Insulation-Walls-Clg.
59. Infiltration-Walls-Wndws
Card -81 Date Card -131 Date
Card -81 Date Card -131 Date
Date FINAL (Plans) OK except #'s
60. Ext. Steps -Door & Sidelight Protection -Landings
61. Smoke Detector -
62. Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor -Ducts -Mach. Protection
63. Bedroom Exiting
64. G.F.I. & Bath Fixtures & Tub Access -Spa
65. Elec. Trim & Subpanel; Breaker Sizes -Labels
66. Stairs & Rails
67. Fireplace or Stove; Clearances -Hearth
68. Elec. Outlets at Wood Panel; Int. & Ext.
69. Kit. Fixt. & Appliance; Grnd. -Air Gap -Cooking Clearance
70. Elec. Outlets & Receptacles at Kit. Counter
71. Garage Fire Door; Swing -Landing -Closer
72. A.C. Duct in Garage -Damper
73. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor-Mech. Protection
74. Plb., Elec. & Mech. Equip. Listed for Location
75. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
76. Insulation -Foam -Looked in Attic ❑ Yes
77. Guard Rails & Deck Construction -Post Caps
78. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth
Clearance Looked under Floor ❑ Yes
79. Following instld.; Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No;
Planters ❑ Yes ❑ No
80. Stucco; Brown -Finish
81. A.C. Unit; Disconnect, Electrical, Plumbing
82. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to
Openings.
83. Water Well; Disconnect,, Electrical, Plumbing
84. Exterior Elec. Trim; G.F.I. Receptacle -Underground
85. Ventilation throughout House
86. Glass Protection
87. Corrections from Previous Inpections
88. Gas Test -Meters Tagged; Gas -Electric
89. Water & Sewer Connected -C/O to Grade -HD Approval
90. Energy Compliance Certificate -Other Certificates
Card -131 Date Card -B1 Date
Card -B1 Date Card -B1 Date
Card -131 Date Card -131 Date
Comments at Final:
(NOTE: An entry must be made each time you visit job site)
i•
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS P 7.'
O., /7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 Cts/
APPLICATFON AND PERMIT
ASSE SOR PARCEL NUMBE
ZON'22
BUILDING PERMIT :
OWNE ,
TELEPHONE
SO. FT. OCC. BUILDING V ATION
ING ADDRESS
OW R'S Mmo
0019 Ongv`
CON CTOR' NAME TELEPHONE
411; 1
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
;
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$ ,
Energy Plan Checking Fee
n
ARCHITECT OR ENGINEER'S MAILING ADDRESS 1
Penalty
$
BUILDING ADDRESS
Permlt fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
rD
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
r
PARCEL MAP
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURA
SF ❑ Duplex❑ Mobilehome❑ Other t & t {^
sPEcl FY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G W
0.00 ea
TYPE OF WORK
New Addition ❑ Remodel a U ilities ❑ Installation[] Other ❑
Describe work: ��
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
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Bushes$
and Professions Code and my license is in full force and effect.SINGLE
License No.31S3 it- Classification —�
Elas 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
NEW ADDNST C DWELLINGS°.c
'/zQsgft
NEW CONSTR. U I.OUTL
NON.RESIO .BRANCH CIRC ITS
2.50 ea
POWER APPARATUS e
OUTLET CIR.
EX. OCCUp(OUTLETS OR FIXTURES
eAL@30ALO 30
FIXED APLNS.
Ex. OCCUp. OUTLETS P(RESID,)REA.)
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. �Yirin 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
o Consent to Self -Insure.
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.
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
Heating
Cooling
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.
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
agajpsgsaid Count in c se ence of the granting of this permit.
Date 7
eOSHAreof Applicant — Owner ElContractor ElAgent ❑work
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 $
TOTAL PERMIT FEE $ ,
0CCOP.
CONST.TYpE
ISCHOOIF,771
PD VHD 13>
This permit is hereby issued under
sions o e Butte County Code and/or
ndi ated abovfor which
ROOF PUBLIC
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
a 16 d
�� Nbtl'r _ I
Receipt No. 1s 744By
WHIT[-O.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. OOLDEHA00-APPLICANT
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COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING D,IVIS,ION
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541
PERMIT APPLICATION DATA SHEET / -
" Permit No. f
OWNER ��Ilejijne A P. No.- r
Proposed Building Use �Q�� Building Inspector Date
At time of permit application, I was advised the following data must be submitted prior to permit processing
° and/or issuance: DATE RECEIVED APPROVED
• 1.
All items have been submitted. . . . . . . . . —
2.
Plot plans in duplicate/triplicate, signed by preparer of plans. .
3.
Complete plans in duplicate/triplicate,f,signed by preparer of plans.
4.
Complete engineered plans and calcs, witih wet signature on plans.
5.
Plans with Energy Design Compliance Statement. . . . . .
6.
School District "Fees Paid" Stamp on Floor Plan.
7
Statement of Intent for Non -Heated and AC Buildings.
8.
Fees of $ . . . . . . . .
9.
Letter of signature authZ�Zfro... izaVn. , � .
Sanitation from
-
approval Health Dept.
" 11.
Planning approval for (A) Use: (B) Parking:
12.
Certificate of Workmen's Compensation Insurance. . . . . .
13.
Contractor's License Information (no., name style, classif.)
_14.
Owner -Builder Verification (Given to owner❑, Mail to owner ❑)
_.--_15.
Improvements may be required. . . . . . . . . . . .
16.
Mobilehome Installation Data. . . . . . . . . . .
17.
Pre-Inspec.request. to (Date)
Pre -Inspection for-------- _ Required. Building Inspector
18.
Recorded copy of Agricultural Acknowledgment Statement.
19.
Driveway Permit. —
_ 20.
Plot plan approval from city of
21.
22.
— — --
` h In you issue the r it roce s as follows: —Mail to owner; Mail to contractor.
' MY KPSs
Telephone and hold for pickup office, Deliver w/inspector.
r
Other�f
Appl ican � Date 7/6 U
Copy of plans sent Health Dept.; Fire Dept., Other Date
The following data must be submitted prior to permit issuance: (Circle new item not checked above).
1.
Index permit for above items No.
2.
Additional items required:
r
Contractor, designer, owner, was advised of above required data by—phone ____rnaiI—counter by date
Contractor, designer, owner, was advised ct above required data by—phone—mail—counter by date
Plans checked by Date 4 Plans approved by Date 2�
Sets of plans on hold in File cabinet AP folder -
1561 1<
Copy—DPW
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'ifications MUST be .4 Coe. &J-
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kept, on -'the job at all times and it is unlawful to
meke any changes or alterations on same with
written permission from the 'Department of
OW iic Works, County of Butie-
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