HomeMy WebLinkAbout056-310-015BUTTE COUNTY SCHOOLS IMPACT FIE CERTIFICATION FORM
(One form per Building)
School District (CC) `-" V I C lb Building Department No.
A.P. Number 05G — 3 10 D 1 -Jurisdiction: City ® County
Property Owner e_ Je I Y1 I,- V 1 ,0 epi � S
Property Location/Address ,r7K &7 I �-' e3oe4 2ei .
Subdivision
Lot No.
Residential Development F
Q
No of Living
Mobile Home
Addition
Units
Installation
Commercial/Industrial
New Addition
Building Department
Sq. Footage 20
(Grou3a�
Sq. Footage 5
(inciuoing txtenor
Roofed Areas)
7 I �,5
Date
V (floor Planes ievie/wed by School District Personnel)
District Identification No. 9 24 J'7 9
School District certifies that►
(Applicant)
(Street Address)
(City)
has complied with the requirements of Resolution No.
representing T square feet.
.CC 7 -
School District Representative
(State)
[) (Phone Number)
(Zip Code)
-n-5 �— 16 by payment of $
JFBi 2926 $
ULL MITIGATION $
17aoz2k
Date
Paid by Check # ( Remarks: h 0 oi.,+ / .
Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with
Government Code Section 66020(a), within 90 days from the date fees are paid. Failure to submit a timely written protest will prohibit
you from challenging the Imposition of the fees in any court action.
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is
notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act (CEQA),
this project may be subject to additional school fees to fully mitigate its impact on the school district's schools.
White (applicant), Yellow (building department), Pink (school district) feeform.xis (2/97)dmm
%
COUNTY OF BUTTE-, DeLartment 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) IlktN 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
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 ( LIV
Social Security Number U
Date 1Joue�' ;� - f go
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.
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 personally plan to provide the major labor and materials for construction of
the proposed property improvement,(yes or no) eS
2. I (have/have not) GLUE 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
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 Security NumberU V
Date X I&W r� 3 , l RSej
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.