HomeMy WebLinkAbout064-170-024COUNTY OF BUTTE,- Department of Public Works
7 County Center Drive, Oroville, CA 95965
OWNER -BUILDER VERIFICATION
Attention Property Owner:,
Phone: 916 -538 -7541 -
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.
I. I personally plan to provide the major labor and materials for construction of
the proposed property imp vement (yes or no)
� 2. I (have/have not) signed an application for a building permit
for the proposed w rk. -
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 4Owner
Social SecuriNu -�
Date %-/"_-7-
"^TE: 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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BUTTE COUNTY SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM
(One Form per Building)
A.P. Number; JC05%-yI ;7- Building Department No. ' c
School District
city county tynp {Jurisdiction
04/nq P406406GCProperty-Owner
Project Location/Address
Subdivision '- �, - L) d Lot Number J
' Residential Development: //
d - Sq. Footage ` 53
# of Living MHI Addition (Group R)
• Units
Commercial/Industrial: Sq. Footage
1 New Addition (Including Exterior
Roofed Areas)
_Jap_i4 ding Department Representative Date
(Floor Plans reviewed by School District Personnel)
R
D'stri Id No.
�. School District certifies that
(Applicant Name$# � � `�'(Phone Number)
(Str t Uddress)
(o ity) %(State) (Zip Code)
has complied with the requirements of Resolution No.
e
ffe„p yment of $��representing 45;� square feet.
r
School District Representative Date
i
PAID BY CHECK NO.
BANK NO
PAID BY CASH
REMARKS: ~� ”
M1r�
white -applicant, yellow -building department, pink -school district
SCHOOL.FEE (8/88)
S.