HomeMy WebLinkAbout056-370-009OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing your siva,
Please complete and return this information at your earliest opportunity to avoid unnecessary ddow
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 Qk NO C3
2. I HAVE HAVE NOT O signed an application for a building permit for the proposed wndc.
3. I have contracted with the following Pia (fin�i) to provide dwpr'oPowd 000stntctm'
NAME:
ADDS
PHONE: 000TRACTOR'S %ICEaE NQ • ' .�;'•
4. I play to. provide portions of this work, but I have. hired the folloa►Ing person m c�ooed0e6
supe vn% andpr6vide themajor w!o&* t
NAME:
ADDRESS: CITY:
PHONE: * CONTRACTOR'S LICENSE NO. y
S. I will provide some of the work but I have contracted (hired) the following persons too prgvida
the work indicated:
NAME ADDRESS PHONE TYPE OF WOkK'
SIGNED:
PROPERTYOVVNER:
SOCIAL SECURITY NUMBER:
DATE: S"' - (./ -- 1 q I . .
NATE: This Owner -Builder Ver (cation is required by Section 19831 and 19832 of tit,
L California Health and Safety Code. This verification must be -compIded and
returned to our office before we are permitted to issue the permit
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