HomeMy WebLinkAbout069-100-030COUNTY_ OF BUTTE - Department of Public Works
7 County Center Drive, Oroville, CA. 95965
• OWNER -BU ILDER -VERIF ICAT ION
Attention Property Owner:
Phone: 916-534-4541
An "owner -builder" building permit has been applied for in your name and bearing
your signature.
Please complete and return this information in the envelope provided at your
earliest opportunity to avoid unnecessary delay in processing and issuing your build-
ing 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 or no)$=.
2. I (have/have not),6�d(/J�E_ 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 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 Qom/
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:
Property Owner
Social Security number —
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
permitted to issue the permit.