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Home My WebLink About005-383-005C- 11 5-383-05 ;I,_ Q RUTH & MELVIN CHRISTOPHERSON O 971 Madison, Chico % Permit#3392-86E(install/Ow el$ e7ser/SF) 005-383-005' ' ' : _ .=93=0045B ` �. CHRISTOPHERSEN, Mel & Ruth a -S_%3 971 Madison St,.Chico CONTR: (sf/seamless siding) NORTH STATE BURS p N I �.:�,.gvh+73�'k• � �. � � f �; G^ t ,ys t ;%TM .,�.r F K•S7' S ��_ '�' �+"-.,'. _ a 5-383-005 93-0045B. �- CHRISTOPHERSEN, Mel & Ruth 971 Madison St, Chico CONTR:' (sf/seamless siding) NORTH STATE BLDRS' COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT No. 7 County Center Drive - Orovllle, California 95965 - Telephone: 916/538-7541 49 APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 005.-383-005-00 ZONING - BUILDING PERMIT OWNER Mel & Ruth Chris ersen TELEPH ME 891-6802 SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 1057 Verde Dr., Chico CA 95926 CONTRACTOR'S NAME North State Builders TELEPHONE 343-7956 CONTRACTOR'S MAILING ADDRESS 3029A The lamed%, Chico, CA 95926 Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is LENDER'S MAILING ADDRESS Filing Fee $ 15.00 Permit Fee2-7, 5-0 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 971 Hardison St. Permit fee $ PLUMBING PERMIT Filing Fee 15.00 Chid CA 95926 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME \, PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S I G I W I @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Uti lities ❑ InstallationE Other ❑ Describe work: _Install sowdees siding _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 600V OR LESS 18.50 200A OR LESS Main service 200ATO1000AI 37.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license Is In full force and effect. License No424499 ClassificatiorlBl, C-61, C-43 ❑ 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 OCCUP.&) 3.64 sq.ft. NEW CONST. ( DWELLING OR ADDNS. ACC. BLDGS. // NEW CONSTR. MULTI -OUTLET @ 5 00 NON-RESID BRANCH CIRC ITS POWER APPARATUS &) (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 20 76 Ex. Occup. OUTLETS FIXED P(RESID.)REAJ I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring g 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. 1 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. Contractor MECHANICAL PERMIT Filing Fee 15.00 Heating Cooling Hood 6.50 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. 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 saaiidd� County in consequence of the granting of this permit. %� �' Date �� r<+' 93 Signature pp ❑ Contractor Agent Si nature of A lican Wner ❑ ® ions over 5'0" deep and demolition or construct- An on oofsHA structures tover required oies in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST TYPE TOTAL FEES . C'�} I HAz I DFEES I IMP FLOOD CDF I PARCEL PD I HD I ISSUE This permit is hereby issued under the applicable provi- sions of the B4tie Coun Code and/or resolutions to do work Indic ted a or which fees have been paid. I C aR OF PUBLIC WORKS By `I/ G- Date73' PERMIT EXPIRES Date / – S - 9 V Receipt No. / 30 41/�+�' WHITE-D.P.W., YELLOW-ASSE330R, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Orovllle, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT RL PERMIT NO �3 - 00 ASSESSOR PARCEL NUMBER 005-383-005-00 ZONING of BUILDING PERMIT OWNER Mel & Ruth Christo hersen Tae EPHONE 891-6802 SQ. FT. OCC. BUILDING VALUATION S OWNER'S MAILING ADDRESS 1057 Verde Dr., Chico CA 95926 CONTRACTOR'S NAME North State Builders TELEPHONE 343-7956 CONTRACTOR'S MAILING ADDRESS 3029A The Esplanade, Chico CA 95926 Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 15.00 LENDER'S MAILING ADDRESS Permit Fee $17-15-12 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 971 Madison St. Permit fee $ PLUMBING PERMIT Filing Fee 15.00 Chico. CA 95926 Each Trap 5.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 7.00 Each qas water heater or vent 7.00 USE OF STRUCTURE SF ❑ Duplex❑ Mobilehome❑ Other SPECI FY Gas piping system 1 - 5 outlets 5.00 Building sewer 15.00 Mobile Home S G W @ 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ InstallationE Other ❑ Describe work: Install seamless siding _ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 15.00 Main service 600VORLESS 18.50 200A OR LESS Main service 200A TO IOOOA) 37.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License ,jo.424499 ClassificationBl, C-61, C-43 ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.S 3.6Q sq.ft. OR ACDNS. (ACC. BLDGS. NE WCU TI.OUT LET NON.R ESID BRANCH CIRC ITS @ 5•00 POWER APPARATUS e (SINGLE OUTLET cIR. ) Ex. Occup(OUTLETS OR FIXTURES 20 @ 76 Ex. Occup. OUED PR TLETS IRESID )EA.) I 3.00 Temporary service 15.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 9 4— Permit Fee $ — WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ❑ 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. Contractor MECHANICAL PERMIT FiIingFee 15.00 Heating Cooling g Hood 6.50 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said Count in consequence of the granting of this permit. X Date /`-- 6—?3 si nature aF A PP lican caner 9 ❑ 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 S Ener Inspection Fee $ Energy P OCC CONST TYPE TOTAL FEES • �D HAz I DFEES I IMP I FLOOD I CDF I PARCEL I PD HD ISSUE This permit is hereby issued under the applicable provi- sions of the Bl to County/Code and/or resolutions to do work indicated �bove f6r which fees have been paid. DIR OR OF PUBLIC WORKS By ��/ Date PERMIT EXPIRES Date y /— - % // 7- Receipt No./ 30 / � WHITE-D.P.W.• YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT OFFICE COPY Address GAS .Meter By Date- COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS r 7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541 APPLICAtION AND PERMIT X_,,PERM�IT NO. ASSESSOR PARCEL NUMBER —r J ZONING BUILDING PERMIT OWNER r• i TELEPHONE K't7 SO. FT. OCC.1 BUILDING VALUATION OWNER'S MAULING ADDRESS, , CONTRACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRRU,CTION LENDER VNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER ;J "I— LICENSE NO. Plan Checking Fee $ Ener Plan Checking F Energy g ee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO.SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF Q Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer o 5.00 Mobile Home S I G I W 10.00 ea TYPE OF WORK New ❑ Addition ❑ Remodel [IUtilities [:1Installation ❑ Other Q Describe work: -f- •-r4- < _ .} r ,r+ „Az - ,, Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 J V OR Main service 1000 AMP ORSLESS 10.00 /r7 t)cl Main service EA. ADD'L too 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 Business and Professions Code and my license Is In full force and effect. License No. Classification Q I, as the owner, or my employees with wages as their sole compen- ' sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed cbntract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLING OCCUP.� , OR ACDNS. (ACC. BLDGS. 2/zQsgft NEWCONST R. U H CIRC NON .R ESID BRANCH CRC ITS 2.50 ea POWER APPARATUS &) (SINGLE OUTLET CIR. Ex. Occup(OUTLETS OR FIXTURES 209501 eAL93o Ex. Occup. OUED APPLNS. R 11 OUTLETS ((RESID 1EAJ 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring g � 15.00 ria t� _ ± - ; i ,.._' Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. 00, 1 shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 against said County in consequence of the granting of this permit. X y Date Signature of Applicant — Owner �r 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 $ Energy Inspection Fee $ TOTAL PERMIT FEE $ G; 7• L1 OCCUP. CON5T.TYPEJ I IFLOODIPARCELI PD I ND I ISSUE This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRECTOR OF PUBLIC By PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date Receipt No. '_ ° ' FW NITE-D.P.W., YELLOW-ASeESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT .-L COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 - - 7 County Center Drive, Oroville — Phone: 538-7541 747 Elliott Road, Paradise— Phone: 872-6307 CORRECTION NOTICE OWNER V PERMIT NO. A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office Immediately. V Y f Inspector Date �F; r COUNTY OF BUTTE out 5� DEPARTMENT OF PUBLIC WORKS . 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Oroville — Phone: 534-4541 Skyway and Elliott Road, Paradise— Phone: 872-2961, Ext. 57 CdRRECTION NOTICE CA- < t 92- P -- OWNER PERMIT NO. A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. Inspector__ _ �t� Dated - COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. / 7 County Center Drive - Oroville, Ca0fornia 95965 - Telephone 916/534-4541 �� APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER — ZONING BUILDING PERMIT OWNER] _ Th .4 TELE PHONE yq C7aV� SQ. FT. OCC. BUILDING VA L TION OWNER'S MAILING ADDRESS r CONT ACTOR'S NAME W,Ne11 TELE HONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER NO �� UNKNOWN al ToValuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHI •TAE�CT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SF X Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home I S G W 10.00 ea. TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities1❑ Installation ❑ Other �-NS Describe work: 1'Gi 1/ Iue i,J ,(cJ 5Crvr c 8 _ reDlQ« /Jor�-, n� eXrS`�r.va w\rtniE, 11 Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 00V OR L Main service 100 AMP ORSLESS 10.00 0.00 Main service EA. ADD'L too AMP 2.50 ,60 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. License No. Classification 1, 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) ❑ Iirsa the owner, am exclusively contracting with licensed contract- 7044) ❑ I am exempt ander Sec. , Business and Professions Codet✓r— for this reason NEW CONST. DWELLING OCCUP.R , OR ACDNS. ACC. BLDGS. /=¢sgft NEW CONSTRESID,MULTI-OUTLETNCHCIRCUITS) NON-RESID BRANCH CIRC ITS 2.SOea /POWER APPARATUS e� l SINGLE OUTLET CIR. EX, OCCUp OUTLETS OR FIXTURES e20050e ALO 30 FIXED APPLNS. OR Ex. Occup. OUTLETS IRESID.) EA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 30-00 Yrs . Ud Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. 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. Contractor MECHANICAL PERMIT FiIingFee 10.00 Heating Cooling Hood 3.00 Ventilation pelt Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon thea ve-mentioned roperty for inspection purposes. I also agree to ave, ' d if k harmless the County of Butte against all liabil'tie fudg n xpenses which may in any way accrue ai s i oun the granting of this permit. Date �/_� Z _00 Tuof Applicant — caner Contractor ❑ Agent ❑ Sig�ofstructures A A permit is required for excavations over 5'0" deep and demolition or construct- ion over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ 67-S-0 occu P. CONST.TYPc I I FLOOD PARCEL PD I NO I ISSUE This permit is hereby issued under sions o the Butte County Code and/or work n icated ab ve for which RE TOR OF PUBLIC BY PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date ! N�°✓ Receipt No. �G2 R.S. () WHITE-D.P.W.. YELLOW-ASSE3SOR, PINK -INSPECTOR, GOLDENROD -APPLICANT C t COUNTY OF BUTTE - DEPARTMENT OF ,PU'B'LIC WORKS - BUILDING DIVISION , 7 COUNTY CENTER DRIVE - OROVILLE,4,C.9d.,LF.QRNIA 95965 - TELEPHONE. 916/53�4-35` 1 PERMIT APPLICATION DATA SHEET Permit No. / OWNER MP !sj„n, C. VNckS4-nnhec-S0.J y A. P. No. S— 3Fr3 mos' Proposed Building Use S Building Inspector Date 11/2— At / 'z At time of permit application, I was advised the following data must be submitted prior to permit processing andJor 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, signed by preparer of plans. 4. Complete engineered plans and calcs, with wet signature on plans. 5. Plans with Energy Design Compliance Statement. . . . . . 6. CUSD "Fees Paid" Stamp on Floor Plan . . . . . . . . 7 Statement of Intent for Non -Heated and AC Buildings. 8. Fees of $ . . . . . . , 9. Letter of signature authorization. . . . . . . . . . . 10. Sanitation approval from 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. 8G� �- G Pre-Inspec. request to Pre -Inspection for 57/Required- guilding Inspector (Dote) 18. IV Recorded copy of Agricultural Acknowledgment Statement. 19. Driveway Permit. 20. Plot plan approval from city of 21. 22. / When you issue the permit, process as follows: `Mail to owner, Telephone and hold for pickup at office, Other x /% ✓i Mail to contractor. _DeIive;r w/inspector,. Copy of plans sent Health Dept., Fire Dept., Other Date - /-12- 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: Contractor, designer, owner, was advised of above required data by_phone_mall—counter by date Contractor, designer, owner, was advised of above required data by—phone —ma ll—counter by date Plans checked by Date ' Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy—DPW — Hours: 10:00 a.m. - 3:00 P.M. COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA 95965 OWNER -BUILDER VERIFICATION Attention Property Owner: Phone: 916-534-4541 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 gaterials for construction of the proposed property improvement (yes or no) . •2. I (have/have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposz& construction: , Aaaxess Phone 4. I plan to "P to coordina Name Address Phone y Contractors License"'No. vide portions of this work -"but I have hired the following person supervise, and provide the major work: ` 5. I will provide so persons to pro Name Contractors License No. �of the w� e the work in Address City but I have contracted (hired) the following meted : Signed: L/ Property Owner Social Security N er Date / / — / --? - F4 - NOTE:- Phone Type of Work NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are per- mitted to issue the permit.