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OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing your signatttce.
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. NO 1
2. I HAVDOS� HAVE NOT O 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: CONTRACTOR'S 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: CONTRACTOR'S 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:
PROPERTYOWNER:
SOCIAL SECURITY NUMBER
DATE: �' /� ` 0 Z—
NOTE: This Owner -Builder Verification is required by Section 198.31 and 19832 oftrite
California Health and Safety Code. This verification must be completed mtd
returned to our office before we are permitted to issue the permit.
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