HomeMy WebLinkAbout063-160-001COUNTY 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) t/�S
( `• I (have/have not) 11'4t1C 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 Numb r
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.
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that the products Wntified below and ren att �ct�ed sheets Nms:, T�._.'are maji ed
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( with the Collective Mark of 'the AMERICAN INST€TUTS QF TIMBER COIVSTRUCTiOI`! (gl'1'C1
anti were : factured in coni mance W,Oh applicable provisions of American tan�lard #ir
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ANSI/All C A190.1-1883, Str, cxur I Glul: Grninaie Timber, and t6 SVP rnanufactura has ar
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been at our plant in T R , which plant, has a Quality nontrol system,
p, Ppprowed by the`Inspection Bureau of the.I�,MERICAN INSTITUTE QF'IM�3�Fj;CONSTRUCTIQN
and ':ins( acted periodically by such Bureau+
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The, manufacture-of these members complies w:th the manufacturing and fabri�,tit�¢� pt�ovi;ions
Cha ter 2�i of t
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Chappr he Uniform Building Coda. . = '�r'` �``` ,','; S 1i tu'Jrxa s� }
• , Keller dumber $alaii for Stock Y� . ; r '�
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Redding, CA406 LOCA*ION!,
P7 #10826' 6/13/86 '3146�p'�i
CU$7pMER',^t ORDER NO �AFf3R'S C7RDER NO,
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American.Laminatars,
° SIGNATURE LLfi fi l! . �., CUMPAI�Y _ r
} $ Quality Control PaJ 46A� Swis6:!ome, OR 7/03/86
y r Y TITLC .._.. ADDRESS _� OATS
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HEREBY CERTIFIES that the said company at its said plant is licensed by the • `�'
ER"CAN INSTITUTE OF TIMBER CONSTRUCTION to use the AITC Callective Mark.in'raspect 4
P wl;ich comply wit applicable provisions,o`► said Standar, d, that the adequacy of the .quality
' n I system in effect �.t said plant is periodically inspected and'verified uy the Inspection Bureau l I ,
e�JIERICAN INSTITUTE OF TIiVICiER CONSTSUCTION aced that, in the'judgment of AITC
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'd man t f complying w�tN� ;applicable manufacturing rind testing .prgyESlons of said
7; n rd in respect of pl oducts manufactu;re,i at said plant. Conformance v�iti�,the Standard �r ;respect „���
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ka srpecif is 'or particulate product is the sole responsibility of the manufacturer; AITC's.gu itzintce a`
reeder bung that the said company is qualified to produce a product. meetir grthe said SYandard ,
d �"at its plant is periodically inspected an], verified by the /�i?'C Inspection Bureau
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q ' j . ,°AITC Certificate Na *
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AMERICAN INSTITUTE OF TIMBER CONSTRUCTION
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' Q 19.83 AMERICAN INSTITUTIE OF TlmetR CONSTRUCTION a
AITC FORM IBCA .
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