HomeMy WebLinkAbout068-030-149MHµ
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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: YESrzzl NO[ ]. '
.2. I HAVEQC] 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:
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
4. I plan to provide por ions of this work, but I have hired the following person to
coordinate, supervise, and provide the major work:
NA�IN E:
ADDRESS: CITY=
PHONE: CONTR•kCTOR'S LICENSE NO.
5. I will orovide some o :he work but I have contracted (hired) the following persons to
provide the work indicated:
NAME ADDRESS PHO`�E 'T'Y'PE OF WORK
SIGNED: _�
PROPERTY OWN��T��R:
SOCL•kL SECURITY NUMBER:���
DATE: ���0J �o
NOTE: This owner -Builder Verification is required by Section 19831 and
19832 of the California Health and Safety Code.
This verification must be completed and returned to our office before
Nye are permitted to issue the permit.
0VER
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