HomeMy WebLinkAbout017-280-010COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, Oroville, CA. 95965 Phone: 916-534-4541
1.
OWNER-iti ILDER VERIF ICAT ION
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 in the envelope provided at your
earliest opportunity to avoid unnecessary delay in processing and issuing your build-
ing 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 or no)
2. I (have/have not) y 12 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: 1
Name '�'47 ►^ �'` to T �- Pt
Address City .0-C
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 ofMwork
S igned :
Property Owner
(?,J�r"
Social Se urity u, ber � qDate r
NOTE: This Owner -Builder Verification is sent t you as required by Se`'ctions 19831
and 19832 of the California Health and Safety Code.-."
This
ode. This verification must be completed and returned to our office before we are
permitted to issue the permit.
To u:::111 -ding De -part
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From.- Environmencta, eal th
Sub j -- - t -0 - SatAtation Clearance
ve 22>-jve
LocatIon
Plans approved f or: 01we-11-
Sewage Disposal
Water
Suppl3l��
Hold f inal f or
Water
Su.pp ly—
F-imal. clearance O.K. for.,
Water
Supply
Clearance for bedroom
mobile homa,. O-L-3--er
011earance for addition of
'Note'"
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