HomeMy WebLinkAbout064-180-019COUNTY 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)
2. I (have/have not) �'[� V si
ned 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:
. /�I^&��1�1 �
Property Owner' ��JII( �i
Social Security Number
Date CIZZ&
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.
BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One Form Per Building)
School District \� _ _ _..... __ _ Building Department No.
A.P. Number ��� l C -_ Jurisdiction (_ at d County
Property Owner
Property Location/Address
Subdivison
Residential Development
[] im
No. of Living
Units
Commercial/Industrial
New
Buildin Department Repre
ative .
Lot No.
Sq. Footage r7l;Z v
Addition (Group R)
0 Sq. Footage
Addition
(Floor Plans reviewed by School District Personnel)
Date
(Including EXterior
Roofed Areas)
We
Distric Identification
4 _School District certifies thatX2
(Applicant) c
(Street Address) (Phone Number)
(City)
has complied with the requirements of Resolution No. __
representing _ —��V _ square feet.
School DistMuMepresentative
(State)
Paid by Check Number_ ��� Remarks:
-
Bank Number
-=
Paid by Cash
(Zip Code)
by payment of $
r
Date
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) feeformmkf (4/92)
I
4 •.
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.
X1. 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) 11aV 2_ 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 conttacted-(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.
BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One Form Per Building)
School Distr (ct, 1111WIS6
A.P. Number(Y! �oU - �� 9' Jurisdiction City
. %
Property Owner L i2
t
Property Location/Address L. a
Building Department No.
Cl>�,,.County,
Subdivison Lot No.
Residential Development Sq. Footage -_720
No. of Living MH I Addition (Group R)
Units
Commercial/Industrial q. Footage
} N"--- .Addition---- - - " (Including Exterior
" Roofed Areas)
Q 9
Buildi g Department Rep66entative Date
(Floor Plans reviewed by School District Personnel)
Dis i t.ldentification No.
Van" 14 1 '�A ISchool District that .
nn
(Applicant)
(Street Addres) (Phone Number)
!�A
(City) (State) (Zip Code)
has complied with.the requirements•of Resolution No... �.. , by payment of $ .I;�,.�j
i �.. t
representing square feet.
�C�AA� 6 r
F7���7
A-5
School Distnc presentative Date
} Paid by Check Number,- _ Remarks:
Bank Number _
•It, -subsequent to thelSchdol District Representativef 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) feeformmkl (4/92)
DRAWN
P L O T P L A N AP#: 84-18-19 sc a I e° 1/* 2 = 1 f o t
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