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HomeMy WebLinkAbout005-433-0171 55-4 1943-89B KREIDER, Larry 781 Cleveland Ave, Chico (reroof/SF) Ou FINALED lqlqO 005-433-017 PERMIT#98-1142 KREIDER, Larry F. 781 Cleveland Ave., Chico `1b4cc1 y Reroof/SF 1 I i i i i II F G i II � U .i;.. -.:,-if""-�:;-,. .�" �'��ji-�-,.^v`ver}.:�{�yt`>-''�`sl+ii.v-y�3-1... :Y�.;r,�" �'.-:w. .',:m�-1, r'i:.�l:.^i:.:. ., .'r�:;�'s.�:•-....�'�7 s�"'"'..."4:rr�c�.,,. :i�.t::^:-.,�y�� '.>:.::�., �w _ � ". - t 005-433-017 PERMIT#98-1142 KREIDER Larr F � y 781 Cleveland Ave., Chico i Reroof/SF G, COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville,. California 95965 - Telephone (916) 538-7541 PERMIT No. (Rev. 12'/96) APPLICATION AND PERMIT z PV_ //4,0 r w ASSESSOR PARCEL NUMBER p•��y ,,.+�, /� +LJI/7`^'latmri'�V3rir7 � (. 1 "� � � •��r ZONING ( BUILDING PERMIT OWNER Y.ARRV VYRRTnRR TELEPHONE SO, FT, OCC. BUILDING VALUATION 1I �1 �j /(� B© SO'. 600.00 OWNER'S MAILING ADDRESS I.A71 RlrrKC Y.W f'idTf` CONTRACTOR'S' ^b77 TELEPHONE TELEPHONE CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER Fireplace LENDER'S MAILING ADDRESS Total Valuation $ 600.00 ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS "UNG ADDRESS Plan Checking Fee $ BUILDING ADDRESS , SQA CUEVELAND AW Energy Plan Checking Fee $ CHICO` PERMIT FEE $ 37.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP i PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE J SF +O Duplex ❑ Mobilehome ❑ Other ; SPECIFY ! Each Trap 7.00 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 O Describe Work: R ROOF I I Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G W I @20.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 - Main Service ( 200A o LEss 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, ( g ) and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION � 1 herebyaffirm under penalty of perjury that I am exempt from the Contractors License p ty p ) y p Law for 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. ❑ I..am exempt under Sec. Business and Professions Code for this reason Main Service ( 200A TO 1000A 46.00 NEW UP. CONST. DWELLING OCC OR ADDNS. ( a Acc. BLDs. SO 3.50x; NEW CONST. MULTI -OUTLET NON-RESID. BRANCH CIRCUITS @/� L%7•50 POWER APPARATUS 8 SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES .00 BAL 20 @ 1,50 - Ex. Occu FIXED APP WS. OR p. ourLErs RESID. EA. 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ WORKERS' COMPENSATION DECLARATION I 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 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 i of one hundred dollars ($100) or less.) `/1 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` �l comply with those provisions. r�� . e_�,(s Date C'' 10 Signature of Applicant O,Owner ❑ Contractor ❑ Agent f 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 $ 37.00 HAZ. D. FEES IMP I FLOOD CDF PARCEL PO HD 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 A l -y' Date PERMIT EXPIRES ON — 'Date f ReceiptNo. 23[,z:,Y.4/_/4 ?�_7 . 0 d WHITE-D.D.S.-B.D. CANARY -`ASSESSOR PINK -INSPECTOR - GOLDENROD -APPLICANT COUNTY OF BUTTE -DEPARTMENT OF DhVELOPMENT SERVICES -BUILDING DIV S'10 7 County Center Drive -�fOrovviillle, Califpirniap�95965 -®Telephone (916) 538-7 1 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT � ASSESSOR PARCEL NUMBER ZONING BUI DING PERMIT OWNER LARRY F_ KREIDER TELEPHONE 343-2858 SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS 4671 HICKS IN CHTCO 10 S • 600.00 CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTOR'S MAILING ADDRESS CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ 600.00 ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ 17.00 ARCHITECT OR ENGINEER'S MAILING ADDRESS Plan Checking Fee $ BUILDING ADDRESS 781 C EVE AN]� Energy Plan Checking Fee $ $ CHICO . PERMIT FEE $ 37.00 LOT NO. SUBDNIS ION'S NAME PARCEL MAP PLUMBING PERMIT Filing Fee 20.00 USEOFSTRUCTURE SF RI Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 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: REROOF Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W 920.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 Main Service ( OV OR LESS A OR tFss 23.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencingwith Section 7000 of Division 3 of the Business and Professions Code, ) and my license is in full force and effect.P License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License L w for 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 I000A 46.00 NEW CONST. / DWELLING .00 S. OR ADDNS. \ 8 ACC. BLDS. SO 3.5¢x; NON-RESND? MULTI -OUTLET BRANCH CIRCUITS @7.50 OWER APPARATUS 8 SINGLE OUTLET CIR. Ex. Occup. OUTLET OR FIXTURES 21 @ 1.00 BAS p .50 Ex. Occup. OUITLETSPRED AP S I'SD.DEA. 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring23.00 PERMIT FEE $ 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 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.) 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 forth ith comply with those provisions. X—_ Date _ _ Sign re of Ap icant JAOwner ❑ CoAractor ❑ Agent An OSHA per Tit is required for excavations over 60" deep and demolition or construction of structures Iver 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $ 37.00 HAZ. I D. FEES IMP FLOOD CDF PARCEL I PD HD 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. r / Date k PERMIT EXPIRES ONITE-D.D.S.-B. Date [�ReceiptNo. ��� 3� D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT 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 prope improvement : YENO ❑ 2. I HAVE19 HAVE NOT ❑ signed an application for a building permit for the proposed w�ock. 3. I have c ntracted with the following person (firm) to provide the proposed construction: : >; ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. 4. I plan to provide portions of this work, but I have hired the following person to coordiia 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 1 SIGNED: r PROPERTYOWNER: SOCIAL SECURITY NUMBER•_ DATE:_ a -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 OWNER BUILDER INFORMATION 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 parry 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 5300 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 contributions. 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 corder 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 contraggrs 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. r rely, Mic el C. Vi. ira, C.B.O. M ger, Building Inspection NOTE. Tris Owner-Builder.lnformation is required by Section 19830 of the California Health and Safety Code: OVER 1 43- 5-433-17 89B KREIDER, Larry 781 Cleveland Ave, Chico (reroof/SF) FINALED i COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville,.CaYiforriia %965 - Telephone: 916/538-7541 APPLICATION AND PERMIT f PERMIT N0. Jy ASSE45S SSOR PARCEL NUMBER , v+y L133 -Ge ZONIIIN BUILDING PERMIT OWNER � TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWNER'S %MAILI�NG% ADDRESS / CONT,RryACTOR'S NAME TELEPHONE CONTRACTOR'S MAILING ADDRESS 1 Fireplace CONSTRUCTION LENDER UNKNOWN 1 Total Valuation $ ~• Filing Fee $ 10,00 LENDER's MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. 1' Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS P Penalty . $ BUILDING ADDRESS 1 Permit fee $ c2 VI 45 0 PLUMBING PERMIT ee 10.00 Each Trap 00 Solar or heat pump water heater00 LOT NO. SUBDIVISION NAME PARCEL MAP y Water piping 00 10e Each qas water heater or vent00 /,r USE OF STRUCTURE SF ] Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets00 Building sewer 00 t Mobile Home S G Wa TYPE OF WORK New ❑ Addition /❑ RemodeI ❑ Uti Iities [:1Installation Describe work: r ,) z;l Tf/,_3 P ,�� C�a�-wr e+ 4 , 10"p? 4,/;w/ ^ /5/.% in. oil j Other ❑ Permit Fee $ Contractor c ELECTRICAL PERMIT Filing Fee 10.00 V i (T 1 Main service 100 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): ❑NON.RESID 1 am licensed under provisions of Chapt. 9, Div. 3 of the !BusinesS and Professions Code and my license is in full force and effect. License No. Classification i 'l, as the owner, or my employees with wages as their sole.compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed, contract- ors. (Sec. 7044) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason OR CONS.T ( DWEACCLLIN G0 CUP.BI\ '/22sgft / NEW CONSTR MULTI -OUTLET BRANCH CIRC ITS 2.50 ea, /POWER APPARATUS 2 (SINGLE OUTLET CIR. Ex. Occu BAL930 Occup(OUTLETS OR FIXTURES 200030 FIXED Ex. Occup. OUTLETS P(RESI D.)REA.) 2.00 Temporary service '10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ i have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. 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. MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling Hood 3.00 Ventilation permit Fee $ Contractor 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County -Ordinances and State Laws relating to building construction, "and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. X / , yt/ , Date L. . /t / Signature of Applicant — Owner ®'Contractor ❑ Agent n/ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ jl TOTAL PERMIT FEE $ `7 OCc"P. CONST.TYPE SCHOOL FLOOD PARCEL P11 I HD I ISSu,E This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS B //" .e ,Date y f/ 61[) PERMIT EXPIRES Date T r ��+19 Receipt No. WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oro lie, -•California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER --i-1 3 3 - v t `7 . ZONI G /L- _ BUILDING PERMIT OWNER TELEPHONE SO. FT. OCC. BUILDING VALU TION 0, ER MAILING ADDRESS 71 141'eks A,,, CONTRACTOR'S NAME O It 9 N -e %— TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ a D Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Flan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ t� CSC � Ci PLUMBING PERMIT Filing Fee 10.00 �) l I -e v C", '1/ c- Each Trap 2.00 j` Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each gas water heater or vent 5.00 USE OF STRUCTURE SF [<plex❑ Mobilehome❑ Other SPECIFY 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 El Remodel ❑ Utilities ❑ Installation 0 Other ❑ Describe work: elf -0 _� �ii✓R �e S K iN f Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 R LE-�cr Main service 1000 OV AMP ORSLESS 10,00 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): F -1I am licensed under provisions of Chapt. 9, Div. 3 of the BuslnesS and Professions Code and my license is in full force and effect. cense 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). ❑ 1,a th(Sece owner, am exclusively contracting with licensed contract- 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. DWELLINGOCCU1..) OR ADDN3. ACC, BLDGS. 1 2/20sgft NEW CON5TR. MU TLOUTLET2,50 NUN-RESID BRANCH CIRC ITS ea (POWER APPARATUS 61 SINGLE OUTLET CIR. / Ex. OCCII o p UTLETS OR FIXTURES 20 @ 50a eAL030 FIXED PR Ex. Occup. OUT LETS 1RESID.)EAJ 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ 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. La"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 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 ' . agai st s d County ' on eyu ce of the granting of this�71 X Pr Datesions ILI/ Signature of pplicant – Owner ` Contractor [I 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 $ OCCuP, CONST.TYPZJ SCHOOL FLOOD PARCEL PD I HD 1 155 This permit is hereby issued under the applicable provi- of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DICTOR OF PUBLIC WORKS 61— 1 By— ate ! PERMIT EXPIRES Date Receipt No. [ Q WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT COUNTY OF BUTTE - Department of Public Works .7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541-. OWNER -BUILDER VERIFICATION Attention Property. Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personallyplan to provide the ma' labor and materials for construction of the proposed property improvement (yes or no) 0 2. I (hav /have notsigned an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone Contractors License No. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address City Phone Contractors License No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work Signed: Property Owner Social Secur'ty /�umbe - .. Date /� l 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.