HomeMy WebLinkAbout069-150-039COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, 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 bailding 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 im/provement (yes or no)
2. I have ave not) 111(11'4— signed an application for a building per
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
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 Secu"riit Number -
Date =T 9 2 ---
-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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BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One Form Per Building)
School District
A.P. Number �c1 — 1 �� Jurisdiction _ City
Property Owner
sin C Qzb_e_�-/_-�
Property Location/Address
Subdivison�
Residential Development
Commercial/Industrial
J
—�
No. of "D v i n g . MHI ' Y .
New
Building Department No.
County -
Lot No
COuWY 9F BUTTE
BUILDING DEPT
MAY 2 1 W2
Sq. Footage
Addition. (Group. R)
0 Sq. Footage
Addition
(Including Exterior
Roofed Areas)
rzJ r
Building Departm t Repres tativeDate
(Floor Plans reviewed by School District Personnel)
District Identification No.
�POfJ, l le i`�Vqr School District certifies that (20 -L
(Applicant
0, Ar ra - - e. ------- --
(Street Address)
S
U; /
(City) (State)
has complied with the requirements of Resolution No 741
representing ,, _ �5 _ _ square feet.
School District Rep
Paid by Check Number Remarks:
Bank Number
Paid by Cash
(Phone Number)
(Zip Code)
by payment of $ 2 410
Date
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee
Certification Form, the School District is notified by the applicable Local Planning Agency that this project
is being reviewed under the California Environmental Quality Act (CEQA), this project may subject to
additional school fees to fully mitigate its impact on the school district's schools.
White (applicant), Yellow (building department), Pink (school district) feeform.wkf (4/92)