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ra ADAMS BUSINESS . FORMS.
COUNTY OF
BUTTE
- Department of Public
Works
7 County
Center
Drive, droville, CA
95965 Phone:, 916-538-7541
OWNER BUILDER VERIFICATION
Attention Property Owner:
An "owner=builder".building petmit`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 mater'als 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
construction:
Name wdAG
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
ti�1.JC� i
Address City i
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.
TO: Building Department
FROM: Encroachment Permit Section
RE: '.,Dftueway,'CIearance
z
6�v Ax".57-fa
( owner location
Z
12, -
AP #
Driveway pe rmit S� has been issued for the above property.
n
Sig ture date
COUNTY OF BUTTE`f- Department of Public Works
7 County Center Drive, Oroville, CA 95965 Phone: 916-534-4541
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
fthe proposed property improvement (yes or ne-)- 1�
2. I (have/ham) 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:
Name ¢ -S
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 .va. . •a -g yC-
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. G
Social Security NumSer
Date 26
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
1-9832 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.