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HomeMy WebLinkAboutmerge (2)4-.41 81-84 ROBERT WIXOM vwv) 1425 7th St, Oroville Contr: Waibel Inc, Oroville jpermit#3742-80M (replace AC) SF B07-0315 031-281-084 MISCELLANEOUS Siding/Stucco VINYL SIDING • 180 LP 1425 7TH ST WIXOM. ROBERT C & GEORGIA FtHAIFE.R,i W. H: - - - 2598B _ Y I 2122P 27729 c r _ 31-281-g4 1425 7th St., Thermalito p CONTR: Bob Brash Const., 884 Inyo St., Chic% i(new, single family) SHAFER, W.H. 3067B(TRANSFER) I" 2598B; "2122P 2772E 1-281-84f p' 7th St., Thermalito' 1425 7 � (new, single family t TRANSFERRED 4/1/64' P VIOUS CONTR: Bob Brash Const., Chico I ` ti 4-.41 81-84 ROBERT WIXOM vwv) 1425 7th St, Oroville Contr: Waibel Inc, Oroville jpermit#3742-80M (replace AC) SF B07-0315 031-281-084 MISCELLANEOUS Siding/Stucco VINYL SIDING • 180 LP 1425 7TH ST WIXOM. ROBERT C & GEORGIA FtHAIFE.R,i W. H: - - - 2598B _ Y I 2122P 27729 c r _ 31-281-g4 1425 7th St., Thermalito p CONTR: Bob Brash Const., 884 Inyo St., Chic% i(new, single family) SHAFER, W.H. 3067B(TRANSFER) I" 2598B; "2122P 2772E 1-281-84f p' 7th St., Thermalito' 1425 7 � (new, single family t TRANSFERRED 4/1/64' P VIOUS CONTR: Bob Brash Const., Chico I ` ti it BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #:(530) 538-7541 FAX#: (530) 538-2140 WEBSITE: www.buttecounty.net\dds FEE INFORMATION DBMSC Stucco/Siding-StoneBric $110.00 LICENSED CONTRACTOR'S DECLARATION Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. X 02/20/2007 Contractors Signature Date WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: ❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by Section 3700 of 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 Number: Exp. Date: (This section need not be completed if the permit is or one hundred dollars ($100) or 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 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. X A: �le�� 02/20/2007 Signature V Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for the performance of the work for which this permit is issued. (3097 civ, code) Lenders Address City State Zip Balance Due: $0.00 Receipt No: OWNER / BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that 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 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]; Please check one of the following: I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORD AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of the property, who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that such improvements are notintended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proof that he or she did not build or improve for the purpose of sale.). ❑1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: The Contractor's License Law dows not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License Law.). ❑ I AM EXEMPT under Section B. & P.C. for this reason: IXi�/02/20/2007 i Owners SignaLLpf Date I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal injury, including death, and property damage caused by, arising out of, or in any way connected with the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte County to enter the above mentioned property for inspection purposes. I hereby certify that I am the pro wrier or am authorized to act on the pro any owners behalf. �� G� o ,fc7�02/20/2007 Name of Per ' ee [SIGN] Print©m Date Owner ❑ Contractor OR; E]Agent for Owner ❑Agent for Contractor FILE COPY -PROJECT INFORMATION Site Address: 1425 7TH ST Owner: Permit No: B07-0315 APN: 031-281-084 WIXOM, ROBERT C & GEORG Permit type: MISCELLANEOUS 1425 7TH ST Issued Date: 02/20/2007 By KEJ Subtype: Siding/Stucco OROVILLE, CA 95965 Expiration Date: 02/20/2008 Description: VINYL SIDING - 180 LF (530) 533-8611 Occupancy: Zoning: AR Contractor Applicant: Square Footage: WIXOM, ROBERT C & GEOR Building Garage Remdl/Addn 1425 7TH ST OROVILLE, CA 95965 Other Porch/Patio Total (530)533-8611 FEE INFORMATION DBMSC Stucco/Siding-StoneBric $110.00 LICENSED CONTRACTOR'S DECLARATION Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. X 02/20/2007 Contractors Signature Date WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: ❑I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by Section 3700 of 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 Number: Exp. Date: (This section need not be completed if the permit is or one hundred dollars ($100) or 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 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. X A: �le�� 02/20/2007 Signature V Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for the performance of the work for which this permit is issued. (3097 civ, code) Lenders Address City State Zip Balance Due: $0.00 Receipt No: OWNER / BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that 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 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]; Please check one of the following: I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORD AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of the property, who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that such improvements are notintended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proof that he or she did not build or improve for the purpose of sale.). ❑1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Provessions Code: The Contractor's License Law dows not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License Law.). ❑ I AM EXEMPT under Section B. & P.C. for this reason: IXi�/02/20/2007 i Owners SignaLLpf Date I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal injury, including death, and property damage caused by, arising out of, or in any way connected with the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte County to enter the above mentioned property for inspection purposes. I hereby certify that I am the pro wrier or am authorized to act on the pro any owners behalf. �� G� o ,fc7�02/20/2007 Name of Per ' ee [SIGN] Print©m Date Owner ❑ Contractor OR; E]Agent for Owner ❑Agent for Contractor FILE COPY $utte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 75965 (530) 538-7601 Telephone (530) 538-7785 Fax www.buttecounty.net/dds OWNER -BUILDER INFORMATION An application for a building permit has been submitted in your name listing yourself as the builder of the 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 $500 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 government 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 to you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. ° For more specific information about your obligations under federal law, contact 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 thier own employees, without a license contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractor 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 contacting the Contractors' State License Board's automated telephone information system at 1-800-321 -CLSB (2752) or by accessing thier website at www.CSLB.ca.gov. PLEASE COMPLETE AND RETURN THE ENCLOSED OWNER -BUILDER VERIFICATION FORM SO THAT WE CAN CONFIRM THAT YOU ARE AWARE OF THESE MATTERS. THE BUILDING PERMIT WILL NOT BE ISSUED UNTILL THE VERIFICATION IS RETURNED. OWNER BUILDER VERIFICATION PLEASE COMPLETE THIS FORM AS REQUIRED BY THE STATE OF CALIFORNIA (SENATE BILL NO. 831 EFFECTIVE JULY 1, 1980). NO BUILDING PERMIT WILL BE ISSUED UNTIL THIS VERIFICATION IS RECEIVED. 1. I PERSONALLY PLAN . O PROVIDE THE MAJOR LABOR AND MATERIALS FOR CONSTRUCTION OF THE PROPOSED PROPERTY IMPROVEMENT.(R NO) 2. I (HAIT/ VkA E N(]� 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 THE WORK, BUT I HAVE HIRED THE FOLLOWING PERSON TO COORDINATE, SUPERVISE, AND PROVIDE THE MAJOR WORK: 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 Description: VINYL SIDING - 180 LF Reference Number: B07-0315 Applicant Name: WIXOM, ROBERT C & GEORGIA Owner's Name: WIXOM, ROBERT C & GEORGIA / AP h Signature of Property Owner: X��f L �/ �Q�-r✓ Date: :031-281-084 71 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OF APPLICA TION Website: www.buttecounty.net/dds "PLEASE PRINT CLEARLY" OWNER INFORMATION Last NameFi ame D i chi Mailing Address 1 t-53�' City 0`O e State/! City Phon Sd o 53-3 Fax E APPLICANT INFORMATION CONTRACTOR Name v Address Z'S9G City Fax State Zip Phone Fax E-mail Lic. # Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name City /'�r� J � Address Z'S9G City Fax State Zip Phone Fax E-mail State License Number APPLICANT INFORMATION Name Address City /'�r� J � Sta7te Z'S9G Phon k_3 o .53.3 �O Fax E -ma /y APPLICANT SIGNATURE X J�s�1/Z a lif/ PERMIT NO. PROJECT LOCATION AP# Property Address City / BIN # 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: a// .0 17 %7 lJSB Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning Flood!ETy-peConst. SRA Yes No Occ. `71% -8U Ole COUNTY -OF BUTTE -`DEPARTMENT OF PUBLIC WORKS 7 CountyCenter Drive - Orgville, California 95965 - Telephone 916/$34-4541 APPLICATJON AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER V. / — 2 y/L ZONI BUILDING PERMIT OwT06re7- IV TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS CON:rAITIi 'S ICE /AjC TELEPHONE 6;3 71 CONTRACTOR'S MAILING ADDRESS i 7 I" f� h �'l !!E� 61 UD. U, 64 CONSTRUCTION LENDER UNKNOWN Fireplace Total Valuation $ LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGI LER'S MAILING ADDRESS Permit fee $ BuL QyN ApDRESS l PLUMBING PERMIT FilingFee 3.00 Each Trap 2.00 Repair drainage or vent piping 2.00 �? /J/ (/ � vIL L Water piping LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 2.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE SF[9' Duplex❑ Mobilehome❑ Other SPECIFY Building sewer Lawn sprinkler system 2.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Uti lities ❑ Installation C Other [' Describe work:��I'�f, C� t.ciN�/(/S/�%� LI ti _ r Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 3.00 Main service 100 AMP OR00V OR LESS5.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST ( DWELING LCCUP.&\ OR ADDNSACCBLOGS.I 20 sq It 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 m license is in full force and effect. y 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 MULTI NON -REST D. BRANCH CIRC ITS 2.50 ea NEW CONSTR. ( POWER APPARATUS & 1 NON•RESID. SINGLE OUTLET CIR. / Ex. Occup(DUTLE TS OR FIXTURES SO a 25C BAL@1OT Ex. Occup.(OUTLETS (RESID )KEA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 6.25 Permit Fee $ Contractor MECHANICAL PERMIT FiIingFee 3.00 WORKMEN'S COMPENSATION INSURANCE 1 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 2 /Z 7` CSI Hood 2.00 Ventilation permit Fee $ 92 d Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all 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 E] 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 $ Land Development Fee $ TOTAL PERMIT FEE $ ao OccuP. GROUP I TYPE OF CONST. I PARCEL PD RD SSUE This permit is hereby issued under the applicable provi- sions'oq the Butte County Code and/or resolutions to do work' ir>,dicated. above for which fees have been paid. / /ADIAEC�OR OF PUBLIC WORKS 4. v By Date G PERMIT EXPIRES Date 7" G _ Receipt No. T 60 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 APPLICATION AND PERMIT PF RII NO. ASSESSOR PARCEL N M R 31-281 —� � ZONIy� Ham– BUILDING PERMIT O WN)�,O 6,5`7- AJ 1Y0AJ TELEPHONE SQ. FT. OCC. BUILDIN LUATION OWNER'S MAILING ADDRESS C ONT��Q C,T¢ggME ./�C TELEPFIPNE ooGG�11 ///`NN///T//�R/�IA.CT��OJJLLr-i75 MAILING ADDRESS y;_,II� `(J� ^�S . oeZ' (�/(/ 700 /D CONSTRUCTION LENDER UNKNOWN Fireplace Total Valuation $ LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Penalty $ ARCHITECT ORENGIN ER'S MAILING ADDRESS Permit fee $ BU�� I}Qyyy DRE55 SE `�1 L� PLUMBING PERMIT Filing Fee 3.00 Each Trap 2.00 Repair drainage or vent piping 2.00 Water piping LOT NO.SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 2.00 Gas piping system 1 - 5 outlets USE OF STRUCTURE r SF u •Duplex❑ Mobilehome❑ Other SPECIFY Building sewer Lawn sprinkler system 2.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ UtiIitiies ❑ Installation❑ �O ier Describe work:�L"CE C06 PEAITI%r Uf er/9 C Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 3.00 Main service jp0 AMP ORLESS5.00 Main service EA. ADD'L too AMP 2.50 NEW CONST.(DWELLING OCCUR.&\ OR ADDNS. ACC. BLDGS. I 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 Professi Code and my license is in fuI f c and effect. y �C% License No.� e � 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 NON -RESIT Rif MULTI -OU BRANCH TLETITS) 2.50 ea NEw CONSTR (POWER APPARATUS a) NON-RESID. \SINGLE OUTLET CIR. soL@1 Ex. Occup(ou XEDTS OR FIXTURES BAL@tOC FIXED APP LHS: OR Ex. Occup. (RESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 6,25 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE 1 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 3.00 Heating Cooling 7 Od Hood 2.00 Ventilation Permit Fee $ oa Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabi 'ties, judgments, costs, and expenses which may in any way accrue again I unt consequence of the granting of this permit. X ?_��.�G Date/ i nature of Applicant — Owner ❑ Contractor ki Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures ove 3 stories in height. Mobile Home Installation Fee $ Land Development Fee $ TOTAL PERMIT FEE $ c ©8 OCCUP. GROUP I TYPE OF CONST, PARCEL PD ND SSUE This permit is hereby issued under sions the Butte County Code and/or wort i icate above for which OR OF PUBLIC PER IT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date `/��v _/ / L/ -/3®f Receipt No. WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT