HomeMy WebLinkAbout079-340-021Hilton Simmons 0-7°1
1186 Mt.Ida Rd.., lot#7, SimmonsSub,Oro.
Permit #2684-77B,P,E,M(new single
family)
OnPA
oa�_�,�;�, 01-0277
FREED ANIEL & KERR ,
1186 MT. IDA R ROVI
CONTR:OWNER�LIVA
�
CONVERT GARAGE INT
036-65-0-}-- 03-1466
FREEDMAN, KERRY
1186 MT. IDA, OROVILLE
RE -ROOF & NEW SHEATHING
91
r
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT X12W - (- �
%_014.01 I
ASSESSUCE�I{UO 021
ZONING
BUILDING PERMIT
OWNER
Kerry Freedman 589-1241
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
30 Sq 1800.00
OWNERS MAILING ADDRESS
1186 Mt. ida Road Oroville
CONTRACTOR'S NAME TELEPHONE
owner
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAIUNG ADDRESS
Total Valuation $ 1800.0
ARCHITECT OR ENGINEER
LICENSE NO.
F11in Fee $ 20.00
Permit Fee $41.00
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
Energy Plan Checking Fee $
PERMIT FEE $
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT Filing Fee 20.00
Each Trap 7.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other
SPECIFY
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: re—roof and new sheething
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.00
Mobile Home I S I G I W @20.00
PERMIT FEE S
ELECTRICAL PERMIT Filing Fee 20.00
800VMain Service 20.AORLESS 23.00
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 is in full force and effect.
License Class Lic. No.
OWNER -BUILDER DECLARATION
hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
JO 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.
❑ 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.
❑ 1 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 sow To 46.00
NEW CONST. DWELLING OCCUP. SO
CCU000A .5,sQ
OR ADDNS. ( a ACC. Bins. 3.5QFT:
=RESID ' MULTI.OLrrLEr CG 7.50
POWER APPARATUSOUTLET
8 SINGLE CIR.
so o 1.00
Ex. Occup. OUTLET OR FIXTURES SAL @ .50
FIXI
Ex. Occup. OUTLETS 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE S
MECHANICAL PERMIT Filing 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.)
d� 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 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.
r1
Date � —C:2 3
X n
Sign t re of plicant - Owner ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ CONST. TYPE
TOTAL FEE $ 61.00
H
DF PARCELPD
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated ove for whic fees have been paid.
B Date /�
PERMIT EXPIRES ON �' /—Q.D.S.-B.
Date
rRecTeiptNo.
D. CAN Y -ASSES OR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 - Telephone (530) 538-7541�� I yPERc�
.ey12/96) APPLICATION AND PERMIT /—
Ar SESSORPARCFI iuMBEA M zom"m BUILDING PERMIT -
OWNER /
TELIEP1ONE- y SQ. FT. OCC. BUILDING VALUATION
OWNERS MLLLA UNO ADDRESS t� 9.3
�7 — ^� ^
CONTRACTOR'S '
TELM40HE
CONTRACTORS MAAIND ADDRESS
coNs VjCTION LENDER
MAru"c ADDRESS '
Fireplace
LENDERS
Total Valuation S
AA004 ECT°RENWNEm
uC ENO•
FGA Fee S 2a.aa
Permit Fee -
ARCNRECT OR ENONEERS MAILM ADDRESS
Plan Checkina Fee S
9uu.oNGADDREsS / �^j ^ /
Q !
Energy Pian Checking Fee S
S
cS
PERMIT FEE S
LOT NO,
.... _...__...____. _...
suaDmms NAME
----------- -'----- -'----
PARCEL MAP
PLUMBING PERMIT Feng Feel 20.00
Each Trap - -- -- ---7:00 -----
USEOFSTRUCTURE
SF ❑ Duplex ❑ Nlobilehome ❑ Other sPEe
Solar or heat pump water heater 23.00
Water piping 15.00
Each mas water heater or vent 15.00
New ❑ Addition ❑
i
Describe Work: —
TYPE OF WORK Gas piping system' 1 - 5 outlets 15.00
W Utilities 17 installation ❑ Other ❑ �_ Building sewer 15.00
_�)�� I joc ( V4co - pill Mobile Home S G W @20.00
Ex. Occup. ovnzr OR FIXTURES
PERMIT FEE S
Ex. Occup. , 'ER,
ELECTRICAL PERMIT
Firing Fee 1 20.00
Main Service
ca EMLss
23.00
Main Service
2-M To 1000A
46.00
NEW ca r.
OWEi.Lm DCCUP.
3.5¢
OR ADONS.i
ALC. SLDS.
mw ....�eccm • f
_ MULT7 OIrrLET 1 14
(x7.50
Ex. Occup. ovnzr OR FIXTURES
gql ,yo
Ex. Occup. , 'ER,
5.00
Temporary Service
23.00
Moble Home Facilities
20.00
Wsc. Wiring
23.00
PERMIT FEE I S
Fee 1 20.00
Hood 1 6.501
PERMIT FES I S
Mobile Home Installation Fee $
Energy Inspection Fee $
Dec CONST. TYPE /&C.)TOTAL FEES
�• I D. FEES IMP FLOOD CDF PARCEL PD ND I ISSUE
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.
By
PERMIT EXPIRES ON
Date
O.B.- I
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 9 NO ❑
2. I HAVE g 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: CONTRACTOR'S 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: CONTRACTOR'S 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: D
PROPERTYOWNER:D
SOCIAL SECURITY NUMMER:
DATE: S—%/— o
NOTE: This Owner -Builder Verification is required by Section 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
OVER
OWNER BUILDER INFORMATION I
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of property
improvements specified.
For your protection, you should be aware that as "owner -builder" you are the responsible party of record on such
a permit Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself; you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business
license from the city or county. They are also required by law to put their, license number on all permits for which they
apply,
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should
be aware of the following information for your benefit and protection:
♦ 'If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is '$300 or more for the entire project, and such persons are not licensed as contractors or
subcontractors; then you may be an employer.
♦ If you are an employer, you must register with the State and Federal Governments as an employer and you are
subject to several obligations including state and federal income tax withholding, federal social security taxes,
workers compensation insurance, disability insurance costs, and unemployment compensation contributions.
♦ There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious
with respect to worker's compensation insurance.
♦ For more specific information about your obligations under Federal Law, contract the Internal Revenue Service (and,
ifyou wish, the U.S. Small Business Administration). For more specific information about your obligations under
State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "owner builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building
permits are not required to be signed by property owners unless they are performing their own work personally.
Information about licensed contractors may be obtained by contracting the Contractors State License Board in your
community or at 1020 N Street, Sacramento, CA. 95814.
Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you
are aware of these matters. The building permit will not be issued until the verification is returned.
rely,
Ic el C. Vi ira, C.B:O.
M ger, Building Inspection
NOTE: 7h is Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.
Gl+/ O.7
i
NOTES
RESIDENTIAL
036-670-021 01-0277
FREEDMAN, DANIEL & KERRY
1186 MT. IDA ROAD OROVILLE
CONTR: OWNER
CONVERT GARAGE INTO LIV. AREA
SPECIAL CONDITIONS
CHECKED
BY
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS -REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
JOB FINALED (Date) D
Signature
t
1'
!t
f
f
j
k
4,
3
j
I
RESIDENTIAL
036-670-021 01-0277
FREEDMAN, DANIEL & KERRY
1186 MT. IDA ROAD OROVILLE
CONTR: OWNER
CONVERT GARAGE INTO LIV. AREA
SPECIAL CONDITIONS
CHECKED
BY
SRA
FLOOD CERTIFICATE REQ.
FIRE SPRINKLERS -REQ.
SPECIAL INSPECTION ITEMS
VERIFY
USE PERMIT CONDITIONS
SUB -STANDARD HOUSING LETTER
JOB FINALED (Date) D
Signature
V=OK
0 = Not OK
- = NotAppMcable
= Not Ready
MOBILE -HOMES
Date
MOBILE HOME UTILITIES (Plans) OK except tt's
Zoning Requirements -Setbacks -Easements
1.
Zoning Requirements -Setbacks -Easements
Footings; Soils -Size -Depth -Spacing -Connectors -Steel
2.
Soils; Special MH Support Sketch
Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
3.
Sewer; Location -Test -Fall -C/O -Concrete
Wood Awn.; Posts- Beams- Rftrs.-Connectors
Shthg.-Frg-Bracing
4.
Water; Location -Test -Easement Needed (Sketch)
Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures'
5.
Electricity; Location-Clearances-Grnd-/ /Amp -Concrete
Carports; Windows -Doors
6.
Gas; Location -Test -Wrap;-/ /" L'ft.
/ P Nat. or / /"L"ft./ PLPG
Electric
7.
Well Clearance & Disconnect
Frmg.; Sills-Anchors-Studs-Rhrs-Trusses
8.
Utility Clearance
Siding; Nailing -Veneer -Stucco -Mesh
10.
Roof; Shthg-Roofing
11.
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
MOBILE HOME INSTALLATION (Plans) OK except k's
1.
Zoning Requirements -Setbacks -Easements
2.
Footings; Size -Spacing -Marriage Line
3.
Gas; MH Test -Demand -Valve -Connector
1.
4.
Electricity; MH Test -Crossovers -Breakers -Clearances
2.
5.
Drain; MH Test -Fall -Flex Connector
3.
6.
Water; MH Test -Regulator -Connector
4.
7.
Water and Sewer Connected -C/O to Grade -HD Approval
5.
8.
Gas and Electricity Tagged
6.
9.
Tie Downs -Type -Installation Cert.
7.
10.
Exits; Insp.-Sketch
8.
11.
Cert. of Occupancy
9.
12.
Permanent Foundation Only; License Decal
10.
Plumb.; Cir. Test -Water Supply Test
Date
Light Niche
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
MISCELLANEOUS
Date
DECKS, COVERS, CARPORTS GARAGES (Plans) OK except #'s
1.
Zoning Requirements -Setbacks -Easements
2.
Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3.
Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
4.
Wood Awn.; Posts- Beams- Rftrs.-Connectors
Shthg.-Frg-Bracing
5.
Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures'
6.
Carports; Windows -Doors
7.
Electric
8.
Frmg.; Sills-Anchors-Studs-Rhrs-Trusses
9.
Siding; Nailing -Veneer -Stucco -Mesh
10.
Roof; Shthg-Roofing
11.
Ext.; Steps -Doors -Landings
12.
Braced Wall Panels
Date
Card B-1 Date Card B -1 -
Date
Card B-1 Date Card B-1
Date
FINAL (Plans) OK except ft's
1.
Setbacks -Easements
2.
Soils; Compaction -Structure Stability
3.
Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4.
Elec.; Receptacles and Lighting, Distance-GFI
5.
Elec.; Pool Lighting; 15 Volts-GFI
6.
Elec.; Enclosures; Conduit Entries -Terminals -Listed
7.
Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8.
Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg.
Boxes- Enclosures-Panelboards-Ins. to Main in Conduit
9.
Health Department Approval
10.
Plumb.; Cir. Test -Water Supply Test
11.
Light Niche
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
,/ = OK
0 = Not OK
- = Not Applicable RESIDENTIAL (Single
= Not Ready
Date Underfloor (Plans) OK except #'s I Date
Date
1.
Zoning -Setbacks -Easements -Flood -Slope
re & Transformer Clearance -Ins. Protection
2.
Ftg., Main; Soils-Elec. Grnd.-/ /" Ftg. Depth
(2�e
3.
Ftg., Garage; Soils-Steel-Elec. Grnd.-/ P' Ftg. Depth
omex Installed Close to Edge of Studs & C.J.
4.
Ftg., Porches & Decks; Soils -Steel-/ P' Ftg. Depth
2 Annlianro r;. ,,;fs in Kitchen & Conductor Size GFI
5.
Stemwalls, Main; Steel-Blockouts-Wrapped
3
6.
Stemwalls, Garage; Steel-Blockouts-Wrapped
Service -Riser Conductors & Ground Main Disconnect
6a.
Hold Downs and Special Anchors
37.
7.
Slab, Steel -Wrapped
oke Detector
8.
Piers -Fireplace Ftg.-Steel
Duct in Ga#ege-DauapaL
9.
D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test
10.
UF, Gas Pipe; Size Anchors - Yard Gas Piping; Size Test
s In arage ..)-Romex Protection
11.
Water Pipe; Test -Anchors -Regulator -Service Test
12.
Electric Underground
Date
13.
Plenums & Ducts; Clearance -Material -Support -Ins.
Card B-1
14.
Girders -Sills -Anchor Bolts-Joists-Vents-Crippies
Card B-1 Date
15.
Access & Ventilation
16.
Insulation
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
PLUMBING (Permit) OK except #'s
17.
Water Htr.; Vent -Access -Combustion Air Baffle
18.
Water Pipe; Test & Anchor -Nail Protection
19.
D.W.V.; Test Fittings & Anchor -Nail Protection
20.
Shower Pan; Test, First Floor -Tub Access
21.
Test Tub & Shower, Second Floor -Tub Access
22.
Gas Pipe; Sixe & Anchors
Date
Card B-1 Date Card B-1
Date
Card B-1 Date Card B-1
Date
ELE TRICAL (Permit) OK except #'s
Card B-1 Date
re & Transformer Clearance -Ins. Protection
Date
lec. Receptacles Spacing -Lights & Switches at Doors
(2�e
Boxes & No. of Conductors Stapled
2
omex Installed Close to Edge of Studs & C.J.
12-! quip. Ground made up w/Mech Fasteners-eQ+d+ G_sR Wafer
28.
2 Annlianro r;. ,,;fs in Kitchen & Conductor Size GFI
2
/ ga. Cu or AI-A.C. Wire Size / / ga Cu or At
3
u or AI -Oven Circ. / / ga Cu or At
Insulated Neutral ❑ Yes O No
36.
Service -Riser Conductors & Ground Main Disconnect
62!
quip. Cle nces Panels-Motors-Mech. Equip.
37.
Clo s Closet Light -Shower Light -Spa Light
Ki+ F�=nr_o Ground -Air Gap -Cooking Clearance
cies at Kit. Counter
oke Detector
Date
Card B-1 Date Card B-1
Card B-1 Date
Card B-1
Date
FINA Plans) OK except #'s
Card B-1 Date
Card B-1
Date
Smoke Detector
MECHANICAL (Permit) OK except #'s
r4aa& r&W&x1 =r-^^ Comb, Air -Conn tor -
In Garage; Above F r•D ctc Protection
66.
67,7VT
35.
A.C. Ducts Insulation & Support
Elec. Trim & Subpanel, Breaker Sizes & Labels
S9.
36.
Vent Fan, Exhaust above insulation
earth
7ec.
37.
Condensate Drain & Overflow, Size & Grade
Ki+ F�=nr_o Ground -Air Gap -Cooking Clearance
cies at Kit. Counter
38.
Furnace -Vent Access -Comb. Air -Return Air Vent 115 outlet
Duct in Ga#ege-DauapaL
39.
Attic Access & Platform if Furnace in Attic
Elec. & Mech. Equip. Listed for Location
7
s In arage ..)-Romex Protection
C
sulation-Foam-Looked in Attic
Post Caps
Date
Card B-1 Date
Card B-1
Date
Card B-1 Date
Card B-1
Date FRAMING (Permit) OK except #'s
Sills Proper Materials & Anchors
fl1 fills Studs -Nailing Spacing & Braces -Plates -Sound
Deffing Walls over Girders & Floor Nailing
S,4 in Walls (rat proof)
4. F' Stops, Furred Ceilings -Stairs -Chasers -Tubs
Headers & Beams -Size & Bearing
& Duplex)
FRAMING (Continued)
Ae'Hangers-Post Caps -Anchors -Connectors
mg. Joist-Rftr. Ties- Purlin-Rolf Brac.-Truss-Shting.-Rfng.
Flue -Fireplace Throat Clearance
Ic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
gi rm. Windows or Exiting Doors -Sill Ht. & Dimensions
51 n Framing
sa �I u Openings
xt. Doors -One 3' -Check Garage 3rd Story, 2 Exits
ise-Run- Land ing-Fire Protection
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
(ding -Nailing Veneer
d -Fd. Vents-Underflr. Access
Glazing Area -Glass Protection -Skylights -Plastic
Its
anels
61. Insulatio -W eilings
62. Infiltration -Walls -Windows
Date Z O
Card B-1 Date Card B-1
Dat Q/
Card B-1 Date Card B-1
Date
FINA Plans) OK except #'s
63.
Ceps -Door & Sidelight Protection -Landings
Smoke Detector
6
r4aa& r&W&x1 =r-^^ Comb, Air -Conn tor -
In Garage; Above F r•D ctc Protection
66.
67,7VT
Bedroom E "
Tab Access -Spa
Elec. Trim & Subpanel, Breaker Sizes & Labels
S9.
70
earth
7ec.
Outlets at Wood Panel, Int. & Ext.
��
Ki+ F�=nr_o Ground -Air Gap -Cooking Clearance
cies at Kit. Counter
g -Closure
Duct in Ga#ege-DauapaL
76.
Wtr. Htr.; Vents -Clearance -Comb. Air Connector-P.R.V.
in Garage; Above oo - cion
Elec. & Mech. Equip. Listed for Location
7
s In arage ..)-Romex Protection
C
sulation-Foam-Looked in Attic
Post Caps
u,.lc rinnr Drainage & Wood -Earth
Clearance Looked under Floor O Yes
82. Following Insild./Drive J Yes D No/Walks J Yes D No/Planters D Yes D No
8
84. fsconnect, ec bing
85 �rnnfc of ,.e rz��r oitin-ennliance-Fireplace-Clea rance to Openings
86Plumbing
xterior Elec. Trim, G.F.I. Receptacle -Underground
4. entilat' Throughout House
kse-6-ass Protection
so. By ectie is !Few ons
94 0- Tegr_m-e-T=gged roc- 1aclric
g nnected-C/O to Grade -HD Approval
Energy C pllance Certificate -Other Certificates
9 dress Posted
Date I (Jj Card B-1 ate Card B-1
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Comments at Final:
LOERKE INSULATION CO., INC.
county
DESCRIPTION OF INSTALLATION
1. ROOF
Material
Thickness (inches)
2. CEILING
INSULATION CERTIFICATE
P
Brand Name .
Thermal Resistance (R -Value)
Batt or Blanket Type—Fiberglass Ott —..___.._.—
Brand Name Johns Manville
Thickness (inches) _ _ _ _ _
Thermal Resistance (R -Value)
oose Fill Type Fiberglass_
Brand Name Johns Manville
_
_ _
Contractor/s min. installed weight/ft sq.D_ 1b.
Minimum Thickness /W/
inches.
Manufacturer's installed weight per square foot to achieve
Thermal Resistance (R Value) 3
—_
3. EXTERIOR WALL
Material Fiberglass Batts
Brand Name Johns Manville
Thickness (inches_ 3,
R-Value)
Thermal Resistance (R-Value)—R----L.57--
=1.4.
4.RAISED FLOOR
Material Fiberglass Batts
_ Brand Name Johns Manville
Thickness (inches)
Thermal Resistance (R -Value)
5. SLAB FLOOR / PERIMETER
Material
_ Brand Name
Thickness
Thermal Resistance (R -Value)
Perimeter Insulation Depth (inches_--_—._--_
6. FOUNDATION WALL
Material _ _
_ Brand Name
Thickness (inches)
Thermal Resistance (R -Value
DECLARATION
I hereby certify that the above insulation was installed in the building at the above location in cc
nformance
with the current Energy Efficiency Standards for residential buildings (Title-24,Part 6, CaliforniaCode
of
Regulations) as indicated on the Certificate of compliance,
where applicable.
C.L.#499150
$ ' O �b 1 LOERKE INSUI
ATION CO., INC.
-ffi(
---
—item Signature, -bate -- --
— �nstaihn-966con
Name]
General Contractor
Co. Name) Or ON
them#s iS'gnaiure-, ga-te
l�nstai if ng con
actor o. ame
Geheral Contractor
(Co.Name) Oro,
Ttem � Signature, ate-' Installing Subcon a
General ctor Co. -N ff
Contractor (Co. (Jame) Or
6_
" a COUNTY OF BUTTE
ry. .
r=, BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street,- Chico, CA • (530) 891-2751
7 County Center Drive • Oroville, CA • (530) 538-7541
�s
CORRECTION NOTICE
OWNER PERMIT NO.
A routine inspection indicates that the following violations of butte county Ordinances exist at the
k? ` above address and should be corrected. Please notice this office when correction of work is
'x completed. If you have any questions pertaining to this matter, or need additional explanation,
please contact this office immediately.
yr G
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 bounty Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT D/ G' 7 -I
ASSESSOR PARCEL NUMBER 036-670-021
ZONING
BUILDING PERMIT
OWNER
TELEPHONE 589-1241
SO. Fr. OCC. BUILDING VALUATION
8,000.00
OWNERS MAILING ADDRESS
1186 MT. IDA. QROVIILE CA 95966
CONTRACTOR'S NAME
00M
TELEPHONE
I
CONTRACTORS MAILING ADDRESS
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $ 8,000.00
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $
20.00
Permit Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
64.35
BUILDING ADDRESS
Energy Plan Checking Fee $
PERMIT FEE $
183.35
LOT NO.
SUBONISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
Each Trap
7.00
USEOFSTRUC7URE
SF IRRX Duplex ❑ Mobilehome ❑ Other
SPECIFY
Solar or heat pump water heater
23.00
Water piping
15.00
Each as water heater or vent
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other XX
Describe Work: CONVERT GARAGE INTO LIVING AREA
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home I S I G I W
@20.00
PERMIT FEE S
ELECTRICAL PERMIT
Fling Fee 20.00
Main Service noon OR mss
23.00
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 is in full force and effect.
License Class Lic. No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law or the following reason:
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.
❑ 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
Main Service 200A TO 1000A
46.00
NEW CONST. DWa ACCELLING OCCUP.
OR ADDNS. ( . BLDS.
SO
3.5¢FT.
NEW
FEOSID. MULTI.OU CUr
@7.50
POWER APPARATUS
a SINGLE OUTLET CIR.
Ex. OCCU OUTLET OR FDRURES
@I50
20 w
B
Ex. Occup. OUTLETFIXED
SRES OREA5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00 23.00
PERMIT FEE $
43.00
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.
❑ 1 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
MECHANICAL PERMIT
Fling Fee 20.00
Heating
Cooling
Hood
6.50
Ventilation
EXTENT) DTICTS
15-0 115.00
_L
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.)
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 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
orthwith comply with those provisions.
• % `p
Date � �� ®C
gna ure of icant - Owner ❑Contractor ❑Agent
An OSHA per Is required for excavations over 5'0" deep and demolition or construction
of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
QQMT
TYPE
TOTAL FEE $ 261.35
HA
D FSS, IMP
✓/
I FLr
cDF PARCEL
I PD
I HD SUE
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated above for hich fees have been paid.
By Date
I/V
PERMIT EXPIRES ON -Z,/ C_
Dale
ReceiptNo. 314604 /,$261 .35
WHITE -D.D.S.-B. D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (530) 538-7541
PERMIT APPLICATION DATA SHEET
OWNER: V 6 —=MAN ASSESSOR PARCEL NUMBER: D_qG — &ZO —OA
Proposed Building Use: jup vmt.-Building Inspector: Date:
At time of permit application, I was advised the following data moat be submitted prior to permit processing and/or issuance:
❑ 1. All items have been submitted.
_- Plot plans, 3/4 sets, signed by the preparer of plans.
3. Complete plans, 3/4 sets, signed by the preparer of plans.
04. Engineered plans, 3/4 sets, with wet signature on plans. All engineering must be shown on plans.
115. Engineered truss details and layout in duplicate (required prior to plan review) No faxes!
�. Energy Design Compliance and supporting documentation. c5{�O�T lQIelkl.
117. Statement of Intent for Non -Heated and A/C Buildings.
C3 8. Hazardous Material Form.
Manufactured Home data and installation instructions including Tie Down Specifications.
10. Fees of $ 1
❑ 11. Impact fees as shown on the attached schedule.
❑ 12. California Department of Forestry plan approyal/fees.
_C�l 3. Flood elevation certificate.
4. Sanitation and plot plan approval Health Department.
❑ 15.'City of Chico plumbing permit.
❑ 16. Plot plan and business license approval from the City of Biggs.
❑ 17. Planning approval for (A) Use: (B) Parking:
Cl 18. Contact Land Development about ❑ Improvements, ❑ Drainage, ❑ Legal Parcel.
1119. Encroachment Permit for driveway (construction approval prior to occupancy).
E120. Pre -inspection for
required.
021. Contractor's license information. (Number, Name Style, Classification).
022. Workers' Compensation carrier and policy number.
9013. Owner -Builder Verification (Given to owner ❑, Mailed to owner ❑).
1124. Letter of signature authorization.
025. Recorded copy of Agricultural Acknowledgment Statement.
❑ 26. Letter of intent on building use.
027. Manufactured Home utility clearance.
1128. Existing violations and/or expired permits.
1129. ❑433 A, ❑Grant Deed, ❑ M.H. Title, ❑ Check to H.C.D $
030. Other: 1469
Whee you issue the permit, process as follows 11 Mail to owner, ❑Mail to contractor.
L4Telephone ���'— ��i. 6 and hold for pickup at 4MI&F office. ❑ Deliver with inspector.
Applicant. _ r ate: A —Q
EXPIRATION OF APPLICATPN
Applications for which a permit has not been issued, will expire by limitation 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.
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 checking fees for work plan checked and other department costs are not refundable.
Original - Applicant Affe�%D / ab 5 /0)
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S�196Q,ELGIN�ST,�-
l:/ "�aORsTL"LE h t
OFiQVILLE?bA95966 t
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N�q, �n�r�uc� (530) 53� 2000xt�
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' ' i' )"-. ' LE. Cry 9_°06
u
y,..�W_�ouraccr?•TEMP RETURN SERVICE REQUESTED
533-2000
RETURN THIS
STUB
-- CUSTU^.IER NUt.13cR
036-670-021-0 FRE0002
-'al;;:.F:_ •.IU"'c=a
036-670=021-0
� CUSiti':I_�'ti`Jia"ccs j �.
FR 0002
aeRViGEaDDRESS
'118335 �MT,�>TDA RD
r�:+` "---`Dc===5:
1186 MT IDA RD
_
'
c i!'``p ��•�I SERVICE TO APdOUMT
CAV
01/01. 03/30 I
03 / 2'1
i
= 2000 2000
2000
j 31.05
-Sew,er,Service .31.0 5
j
DANIEL & KERRY
FREEDMAN
.,.. ',.
I
1186 MT IDA RD
• .;
OROVILLE CA 95966
Total------------- >� 31.05
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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. 1 personally plan to provide the major labor and materials for construction of the.-.
proposed property improvement YES[V] NO[ I.
i.
2. 1 HAVE[ 19] HAVE NOT[ ] signed an application for a building permit for. the:,.,
proposed work.
3. 1 have contracted with the following person. (firm) to provide.: 14p 'proposed
construction:
NAME:
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
4. 1 plan to provide portions of this work,,- but I have hired the -following pdddWt'o
coordinate, supervise, and provide the major work:
NAME:
ADDRESS:
CITY
PHONE: CONTRACTOR'S LICENSE NO.
5. 1 will providt some of the work but I have contracted (hired) the followipg+ers . ons to
provide the work indicated:
NAME ADDRESS PHONE TYPE OF
SIG rf ED:
TAy.
PROPERTY OWNER: JMWV
DATE:
NOTE: This owner -Builder Verification is required by Section 19831 and
19832 of the California HealthandSafety Code.
This verification must be completed and returned to our office'before
we are permitted to issue the permit.
Dear Property Owner.
An application for a building permit has been submitted in your name listing yourself as the builder of
property improvements specified. `
For your protection, you should be aware that as "owner -builder" you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are personally
performing their own work. If your work is being performed by someone other than yourself, you may. protect
yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all permits
for which they apply.
If you plan to do your own work, with the exception of various trades that you plan to'subcontract, you
should be aware of the following information for your benefit and protection:. -
0 If you employ or otherwise engage any persons other than your immediate family, and the work (including
materials and other costs) is $300 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
0 If you are an employer, you must register with the State and Federal Governments as an employer and you are
subject to several obligations including state and federal income tax withholding, federal social security taxes,
workers compensation insurance, disability insurance costs, and unemployment compensation contobutions.
0 There may be financial risks for'you if you do not carry out these obligations,'�and these risks are especially
serious with respect to worker's compensation insurance. `
0 For more specific information about your obligations under Federal Law, contract the Internal Revenue
Service (and, if you wish, the U.S. Small Business Administration). For more specific information`about your
obligations under State Law, contact the Department of Benefit Payments and the Division 'of Industrial
Accidents.
If the structure is intended for sale, property owners who are not licensed contractors ;are allowed to
perform their work personally or through their own employees, without a licensed contractor or subcontractor, only
under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "ownerbuilder"
building permit, erroneously implying that the property owner is providing his or her own labor and material.
personally. Building permits are not required to be signed by property owners unless they are performing their ow'n'
work personally.
Information about licensed contractors may be obtained by contracting the Contractors State License
Board in your community or at 1020 N Street, Sacramento, CA. 95814.
Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm,
that you are aware of these matters. The building permit will not be issued until the verification is returned.
ly,
Mc el C. Vi ira, C.B.O.
Madager, Building Inspection
NOTE: This Owner -Builder Information is required by Section 19830 of the California Health and Safety Code.
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11
1
ADDITIONS TO RESIDENTIAL, BUILDINGS ENERGY SHEET
PACKAGE COMPLIANCE
ower /mel Climate zoite
Permit N — Z%'� Floor Arta
The following dept showing mwdatory and rogulrod feaures shall be lmealled for additions to dwW140. Additions to dwW114p
1nt:ltrde mora addition, convorting garages and patio: to livlgg area% house moves that add &atoge and lade eonverslonkmW
any spatx fiat Is eatisting non-conditiortod space 61st is wnwrtod to conditioned space. Ranodding of existing condidoned
space it not included.
Climate Zona-Ll-and16•
t
Component
i
Cellldg 201.
R-38
Wan Ins.
lo
R iS
Floor Ins.
R -1S
Slab Edge Ins.
R=19
Glass (U)
NR
Max. Glass
Shading Coe ff (S&N)
.75
Shading Coeff (W&E)
Thermal Mass
Heat, Elect Resistance
Heat, Gas
Heap Pump Split Sys.
Heat Pump Package
Cooling Split Sys.
Cooling Package
Increased M of Wtr Mrs
*One entry/cohimn —
—awr �alaa
tui-4YY
300 <1Q00 sqR
R-
R-38
R-38
lo
R iS
P-45--)
R -1S
-
R=19
R-29
NR
NR, R-7
.7S
.75
65,60
SO sqR
y—* Removed
}
16% + Removed
NR
.66
.66
NR
A0,66
.40, .66
NR
S% Raised
S% Raised
20% Slab
20% Slab
Not Allowed
Not Allowed
Not Allowed
AFUE 78%
AFUE 79%
AFUE 78%
HSPF 6.8
HSPF 6.8 N
HSPF 6.8
HSPF 6.6
HSPF 6.6
HSPF 6.6
SEER 10.0
SEER 10.0
SEER 10.0
SEER 9.7
SEER 9.7
SEER 9.7
Allowed w/ talcs.
Allowed w/ roles.
Allowed w/ oaks.
req both zones. 2nd
/
loose Fin v4watton (Dens
Grrttttutat Coatrot (WadrastriP doon.artiried �rMdo..e, nnecing)
VV" barren (Zone 16)
Ducts Per Uniform mochardcal Code - at to
Lighting 1 ad" and Bath not Iota than 40 LwncndWett
Desipt Compliance Statement: The Am building des' the roauire is of Titk 2+. Parts I ad 6 or the Caliromal Code of Repttatiow.
(Prope owner/contractor) y
TTS .
Ta •.a 7TCOC4MoacC oo 1 Un—us I oa.j ^,. .. ,- a nw o
2684-7 �B P -'E ;M
PERMIT NO.
� PERMIT EXPIRES
i°'OWNER Hilton Simmons
�° CONTR. owner
LOCATION (A. P. 36-67-21 )
4 1186 Mt. Ida Rd., lot #7, Simmons Sub, Oro;
;4
'F
.. f
Temp. Power Pole
Called PG&E
Temp. Elea Serv. S--/ `7 %
'7 �t
_/ �71�
Cayled PG&E
Te w/ Gas Serv.
- Called PG&E
JOB
�'`�
S
FINALED /
(Date)
(Signature)
s ,
F
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION' RECORD
BUILDING BUILDING (Cont,d)
PLUMBING
Setback
Firewall rjd`Gi
Soil Piping
Forms
Parapets
1st Floor
Main Bldg.
Restroom Finish
2nd Floor
Footings
Windows
3rd Floor
StemwaII
Siding
To out
Slab
Roof Sheathln
Water Piping
Piers
Roofing14 zo 0:2
Sewer
Gara aFdn.
Vents
Fixtures
Footings r
Stemwa I I
d Garage Vents
insulation
Water Htr. '
Heaters
Slab
Carport
Footings
Prov. for ph sically
handica ed
Conformance of ex.
structure
Appliances
Gas Piping &Test
Temp. Gas
Slab
Final
Sanitation
Patio
WRIEPLACE
Final r Cdr%•%
Footings
o o t I n g >7 , 22
ELFECTRICAL
Masonry Walls
Throat
Rough
Relnf. Steel
Final
Fixtures
Bond Beam
FIRE SP IN ERS
Motors
Framing 7i
Test
Water Htr.
Stucco
Final
Sub aneIs
Mesh MECHANICAL Grd. Fault Pro .
Scratch Heating— Service
Brown Cooling Temp. Pole
Finish Ducts Underground
Interior Lath Ventilation Permanent
Door Closer Final Final
MOBILEHOME TILITIES------------------ Elec_ Service Elec. Pedestal
Water Piping Sewer Gas Piping
MOSILEHOME INSTALLATION - - - - - - - - - - - - - Support Elec. Continuity
Water Piping Drainage Gas Piping
ti
DATE REMARKS OR CORRECTIONS
(NOTE: An entry must be made on this form each time you visit the job site.)
116 4/
THIS I$ TO CERTIFY THAT INSULATION HAS BEEN INSTALLED I CONFORMANCE WITH THE CURRENT REGULA-
TIONS, CALIFORNIA ADMINISTRATIVE CODE, TITLE 25, STATE OF CALIFORNIA, IN THE BUILDING. LOCATED AT:
Street Lot Number Tract No.
EXTERIOR WALLS C
Manufacture Thickness/Type-,2— - R Value
CEILINGS
Batts: Manufacturer Thickness R Value
Blown: Manufacturer Thickness No. Bags -3—<:7 Wt./Bag
Sq. Ft. Covered 9/ R Valu
FLOORS
Manufacturer Thickness/Type R Value
SLAB ON GRADE
Manufacturer Thickness/Type R V
Width of Insulation inches
FOUNDATION WALLS
GE
R Value
'INSULA N CONTRACTO HAWKINS INSULATION CO. LICENSE a. 215-925
B TITLE ��"'� DA
__7
4
COUNTY O'F'BUTTE — DEPARTMENT OF PUBLIC WORKS
1 „ 7 County Center Drive = Oronilie, California 95965
2c4
Telephone: 534-4541
APPLICATION AND PERMIT
icNl c.�cn wu=U11AP
Y UI OUIIC lU VIRVI UPUII Ule
abov -mentioned propn purposes.
Date 6112
Signature of Permitee or Agent
Receipt No. AKIY
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 —, , c Date 6, -2 7
Bdd�ding permit expires Date 6 - 7-b `? p
BUILDING
Owner 1
r
SQ. FT. OCC. BUILDING VALUATION
O0
Mailing Address
Telephone N S
0
Fireplace OU
Contractor
Total Valuation
Mailing Address
Permit Fee CPQ
Plan Checking Fee&/or Penalty
Telephone No.
_f
Building Address v O
Permit Fee
PLUMBING No. @ FEE
PERMIT FILING FEE $3.00 z 00
Each Trap 1,50 — 6
(O /
Repair drainage or vent piping 1.50
Water piping 1.50
Zoning Verificaftn Only
Each gas water heater or vent 1.50
A. P. NoZ
Zo
Gas piping system 1 - 5 outlets 1.50
Each additional outlet .30
Fee ifIWC.
/
n
Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00 v
EQA
Parking
Plans
Parcel
Declaration
P 60' R/W
m r
Improvements—
p ovements
Lawn sprinkler system 2.00
Bldg. P ns Recd
P el o a l
Plans royal
Permit Fee $
NEW ADDITION ❑ UTILITIES ❑ OTHER ❑
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00 Q
Main service 1000V OR 0 AMP ORLESS5.00
Main service EA. ADD'L 100 AMP 2.50
Single Family Duplex ❑ Mobil Home ❑ Others ❑
Main service OVERAMP OR LESS 25.00
Main service EA. ADD'L 100 AMP 1.00
NEW CONST. I DWELLING O
OR ADDNS. ACC. BLDGS) 22sgft
NEW CONSTR. MULTI.OU T
NON-RESID. BRANCH CIRCUITS) 2.50ea
NEW CONSTR. (POWER APPARATUS &)
NON.RESI D. SINGLE OUTLET CIR.
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business 81 Professions Code under the name
style of:
Y
Ex. Occup(OUTLETS OR FIXTURES) 50 BAL21
01
Ex. Occup. ( )
OUT ETS ((RESID.)REA 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
i I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$ell3'(
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.
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
MECHANICAL No.1 @ FEEPERMIT
FILING FEE $3.00 (, 0
Heating p D
Cooling U d Q
Ventilation
Hood 2.00 1 a 0
Permit Fee $
�E
$ �" a
TOTAL PE MIT FEE
icNl c.�cn wu=U11AP
Y UI OUIIC lU VIRVI UPUII Ule
abov -mentioned propn purposes.
Date 6112
Signature of Permitee or Agent
Receipt No. AKIY
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 —, , c Date 6, -2 7
Bdd�ding permit expires Date 6 - 7-b `? p
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