HomeMy WebLinkAbout065-350-036COUNTY OF BUTTE - Department of Public Works
7 County Center brive, 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) 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 (o
Address City
Phone Contractors License No.
4. I plan to provide portions of this wcrJC, but I have hired the follow.irg 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
Ala
S igned : `/
Property Owner Y60- E
Social Sec ri y Number
Date
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
19832 of the California Hea.lth.and Safety Code.. _
This verification must be completed and returned to our office before we are per-
mitted to issue the permit.