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COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, Oroville, CA 95965 Phone: 916-538-754.1
0[TNER._-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 mateials 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. 1 have cont acted with the following person (firm) o provide he p pos
construction. e('
Name _ X11
Address City
Phone Contractors License No.
4. I plan to provid portions of this work, butI ha ired the following person
to coordinate, su ervise, and provide h major rk:
Name
Address Ci
Phone/` Contract s Licen e M_.
44—
5. 1 will provide. of the work but I have contracted444
the
person provide the work indicated:
me Address Phone Type of Work
- O
Signed;
Property Owner_
Social Security -16'mbe
(>
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.
M
_COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541
C.
OWNER -BUILDER VERIFICATION,-
An
ERIFICATION.
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 materiels for construction of
the proposed property improvement (yes oa:a ')
2. I (have /ham) -: g � % signed an application for a building permit
for the proposed work.
3.
4.
1 have contracted with the follo
construction:
Name
Address
g person (firm) to provide the proposed
Phone Contractors License No.
I plan to provide portion, of th
to coordinate, supervise, and pr
Name
Address
Phone Contractors License No.
City
work, but I have hired the following person
de the major work:
City
5. I will provide some of the work but have contracted (hired) the following
perscns.to provide the work indic ed:
Name Address Phone Type of Work
Signed:
Property Owner U
Social Security umber,/
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.
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