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HomeMy WebLinkAbout017-280-014COUNTY 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 personally plan to provide the major labor and materials 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 proposed construct' n: Name Address 3 City Phone O — <Z4 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 Security Number / Date 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. I f BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION#: OROVILLE: (530) 538-7636 • CHICO: (530) 891-2834 OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION **PLEASE PRINT CLEARLY** OWNER Name �,tJ Last Name -T A -A First Name City C� State�, Zip Z� Address / LK � A -K— e P? t City C Co 00 State OW, Zip Phone(( �� � Fax E-mail E-mail State License Number CONTRACTOR Name �,tJ Address S CIF— City C� State�, Zip Z� -Phon E-mail Lic. # / 0 65-q'31 Class'B APPLICANT NAME ARCHITECT/ENGINEER Name CityState (o Address Phone 3 `f 3 D2� Fax l City Subdivision Name State Zp Phone Lot # Fax E-mail Date Approved: State License Number APPLICANT NAME _ Name Nk ti Address -• - CityState (o Zip Phone 3 `f 3 D2� Fax l E-mail APPLICANT Sj2NMRE X For office use only: ' / AP# 011—,q ry ` 121 n/ Zoning Flood Zone SRA Yes No Occ. WORK! 'S COM ENSATION Type Const. Subdivision Name If hiring anyone other than license a certificate of worker's compensation must be shown at the time of permit issuance. Map Book Page Lot # Planner Date Approved: OVER FOR SUBMITTAL REQUIREMENTS K:\FORMS\BUILDING FORMS\BldgApplSubRgmts.doc Page 1 of 2 PERMIT NO. � �_ 3 P BIN # LOCATI N ' / AP# 011—,q ry ` 121 n/ Prope re C 6 -X ��© City vCZI Cross Street WORK! 'S COM ENSATION Policy Number 73 W Carrier [contrtra�cttoorss, If hiring anyone other than license a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY -Nam Address Description or Scope of Work: Sq. Footage ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Received by: le- Amount: Bldg SRA Receipt #?q/WRS Sheriff CK#; SMTP Other Date: Total REV 7-27-04 TO: Building Department FROM: ..Environmental Health, Chico SUBJECT: Sanitation -Clearance Owner 'Location AP# Plan approved for: sewage disposal water supply Hold final for: ; . * . water supply Final clearance O.K. for: water supply Clearance for 3 bedroom—mob44-e home. Other 2, Note*** i-anitarian �Vzz"9,4' Date