HomeMy WebLinkAbout042-680-0380n(J`7"I•, or '="-7* L'
7 C�uncy ,Czntz"r Or'.Ve Orov_Ilz, C_, 9:361 Phone
0 r. -YE .1 - 3 TJ T ER VEZS: =CATION
:encion ?_ooercy Owner:.
An "owner -builder" building per=it has been apoLied for in -your name and bear iag
tr signature.
Please ccmoleca and recur:t Ch -3 iaformacioa ac your earliest opportunity to avoid
iecessar7 deLa7 is processing and .issuing your. building .permit. No. building. perait
.1 be issued. until this verification: is received:
I. I personally plan. cc'prov_de.the major labor and materials for ccnscruc_ oa of
the proposed pro0ert7iMercveaenc'� or co) %
Z. I av /have acc) - \off 0.V ' signed 'ad application for a building permit
for the proposed.work.
3. I have coacrac_ed wtch'che following persoa (firm) to provide the proposed
construction
Name IQ
Address I.Citi
Phone Coe _attars License No.
4. I plan to provide portioas of this work, but .I have- hired the fo Ilowing person
to coordinate, supervise, ad provide the major work:
Name "
Address Cic7
Phone L:ce*se No ...
5. 174-11 prow da some oz 'the gorl.t but I have concractad (hired) the faUcw ng
persons co provide the .%nor:t iadic3tad:
Name Add -ass I Phone Type of wcr'.t
S ig a ed : \�
P_ooerty Owner
Soc_aL Securit7 N ce
Dace
L_: This Owner-.3ui1d`er Veri=_cation is sent cr ;rou ss reeuired by Seccioas 19831 and
1983-6 of the Cali -'or -,iia Lrealch. and Sasacl'Cade: .
This veriJ2.icat4_on must be complecad and returned to our office before we are per-
mictad to 'issue .the pernic.
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