HomeMy WebLinkAbout066-040-017OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner builder" building permit has been applied for in your name and bearing your signapi,
Please complete and return this information at your earliest opportunity to avoid unne c essaty dWW
in processing and issuing your building permit. No building permit will be issued until this
verification is received.
1. I personally plan to pro4,,0q,_ajor labor and materials for construction of the proposed
property improvement :NO
2. I HAVE)f HAVE Ned an application for a building permit for the proposed wak•
3. I have contracted with the following person (firm) to provide the proposed constriction-,
NAME: _ _ LA p 1<,u
ADDRESS: . Cr ••
.t
'PHONE: CONTRACTOR'S LICENSE NO.
4. I plan to. provide portions of this work, but I have. hired the following -person to coordioii%
supervise, and prdeide the major work: „ .
NAME:
ADDRESS: CITY.-
PHONE:
ITY:PHONE: CONTRACTOR'S LICENSE NO.
55.E I will provide some of the work but I have contracted (hired) the following . g persons topmvtde
the work indicated:
NAME ADDRESS PHONE TYPE • OF WORK -
SOCIAL SECURITY NUMER:(
DATE:
NOTE: This Owner -Builder Verification is required by Section 19831 and 19832 ofdie,
California Health and Safety Code. This verification must he completed wd
returned to our office before we are permitted to issue the permit.
OVER
r
School District
A.P. Number
BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One form per Building)
PA9 i .e. tc�t u H + Building Department No.
0 to G `Eu�sdiction: .City County
Property Owner I Pr Z'1. or / ! 1111 T, W1 Kt 1 21 , 1\ IC:. 11111 M A ex
Property Location/Address
Subdivision
11\A Q A t; fir . %A . La t I Ie $
1...o U/% �I c l 1..i �'t YJ tklq
Lot No.
Residential Development ® Sq. Footage , no
No of Living Mobile Home Addition/ *Supplemental to (Group R)
• Units Installation Conversion Permit #
*(No foundation ins on)
CommerciaUlndustrial Sq. Footage
New Addition (Including Exterior
Roofed Areas)
Building Depart
Irioor runs rev,eweo dy zscnool u,stnct rersonnell
. 3
Ztrit Identification No. q �
_0 /,4j, v School District tifies that
(Applicant)
cer��
(Street Address) (Phone Number)
-V
�-- q 5-� J
&�g A=
1 ,ty) ( (State) IZiN Code)
ment Representative
Date
has complied with the requirements of Resolution No.
representing square feet
School District Representative
by payment of $ '5//� 4�
Remarks:
Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with
Government Code Section 660201a1. within 90 days from the date fees are paid. Failure to submit a timely written protest will prohibit
you from challenging the imposition of the fees in any court action.
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the Scholl District is
notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act ICEQAI.
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) feeform.xI
j
i I
S
AB 2926 $
FULL MITIGATION = .
Date
Paid by Check !1 '