HomeMy WebLinkAbout065-330-019COUNTY 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)�.5
2. I (have/have not) -.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 contracted (hired) the following
persons to provide the work indicated:
Name Address Phone Type of Work
Signed:
Property Owner I xzVt,0_
Social Security Number /
Date Z
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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BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One Fdrm Per Building)
School District L% .S — _ Building Department No.
A.P. Number b / nJ�J /_ Jurisdiction City �ounty
Property Owner 6Vtz L, J a Nw,f -Z .
Property Location/Address
Subdivison� n/�✓e00N Lot No. !Y `93
Residential Development 0 Sq. Footage
No. of Living MHI Addition (Group R)
Units
COUNTY OF BUTTE
6BUILDING DEPT
Commercial,llndustrial 0 0 Sq. Footage
MAY 19 New Addition (Including Exterior
Roofed Areas)
Buil Department: Representative Date
(Floor Plans reviewed by School District Personnel)
Disc Identification No.
'D
16
(Street Address)
674
tZ School District certifies that r
(Applicant)
has complied with the requirements of Resolution No. —
repres ting/W/ " ���— square feet.
4 wti
Sch of i rnct e- resentative
(Phone Number)
(State) (tip Code) ' p�
by payment of $ /
Date ,.
Paid by Check Number _ _ Remarks: If this IL3ert i c rPvi Pw,-d iindPr CFOA, the
Bank Number J- project may he a„hiart to—additional schoo'
'.Paid by Cash. _ _
/
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.
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White (applicant), Yellow (building department), Pink (school district) feeform.wkl (4/92)