HomeMy WebLinkAbout068-010-002COUNTY OF BUTTE - Department of Public Works
7 County Center Diive, 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 ma' labor and materials for construction of
the proposed.property ,improvement yes or no)
2. I( ave ave not signed an application for a building permit
forroposed 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
Signop y � Q Q
Property ert Owner
Social Security umber -.--
Date f C) Z f 5 2 -
NOTE:
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.
i
COUNTY OF BUTTE Department of Public Works
7 County Center -Drive, Oroville, CA 95965 Phone: 916-538-7541
OWNER -BUILDER VERIFICATION
Attention Property Owner:-
An
wner:
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 ma' labor and materials for construction of
the proposed property improvement (yes or no)
2. I hav /have not) signed an application for a building permit
for a proposed work.
3. I have contracted with the following person (firm) to provide the proposed
construction:
Name
Address_. City
-Pho-ne 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: Cj
Property Owner
Social Security Nu ber
Date t d Z fri �-
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.