HomeMy WebLinkAbout069-180-007I
c BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
K,
+ (One form per Building)
School District
�V� :_ ,/� Building Department No.
R.P. Number ��q_ / _ oQ7 Jurisdiction: City County
Property Owner �� /•/ -� ^C�pi C�
Property Location/Address
Subdivision
Residential Development
Commercial/I Adustrial
Building Department
Lot No.
............................................................................................
=.................. 0 0
Sq. Footage
No�IUgMobile tHome Addition/ Supplemental to (Grou R)
Units Installation Conversion Permit #
i '(No foundation inspection):
...Y .................... ..... ........................................
F Sq. Footage •
New Addition a (Including Exterior
Roofed Areas)
4z 4 a --
Date
(Floor Plans reviewed by School District Personnel)
District Identificabon No.
F1 P� �,�p�y.ytp „� School District certifies thatf,�,Q
(Applicant)
(Street
f
(City) V (State)
has complied with the requirements of Resolution No. / _ Q — / Q by 1
.2S9! <J& 7 <G3 >
representing ��_ square feet. AB 2926
FULL MITIGATION ++
_ 1
School Distrilt Representative
Paid by Check N ` �Remarks: _
Number)
of $
s
s
A
Dat / �—
I
11+ 1- -- < 3 7 ?d l D 'S'Il0 7. S M Y
Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with
Government Code Section 66020(a), within 90 days from the date fees are paid. FailSre. o submit a timely written protest will prohibit
you from challenging the "imposition of the fees in any court action.
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 ICEQA),`
this project may be subject to'additiona(Ischookees to fully mitigate its mpact on the school district's schools. ;
White (applicant), Yellow (building d partment►, PinO(school district feeform.zis (10/98)dmm
a
COUNTY OF BUTTE - Department of Public Works
7 County Center Drive,.Oroville, CA 95965 Phone: 916-538-7541
OWNER -BUILDER VERIFICATION
Attent_on 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 (yes or no)
' 2. I (have/have not) signed an application for a. building permit
for the proposed wor .
i. 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 (�'l�p
Social Security Number ' �
Date 3--/ S7
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.
_1
NOTE: --All
Accord -an 6 wiih tnecognized Good Practic9
c I , I acified use in 1he
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all smoke detector pef coa�).
This set of plans aM specifications MUST be
kept on the job a! all times and it is unlawful to
make any changes or altorations on samx-, without
written parmission from the Departmont of Pub6c
Works, County of eufto_.
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BUILDING DEPARTME-',F1'
A P P R 0 V E D
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S, typiczA,
Location of &
equipmont �41all ba �"S bhown
& CIORr ' ,
Of all eaSWWAS-
1� PV tP 1A
\dA
flo"r )i 4*4 041L pi'"A)
- -roarl 1,)(( .
-4,040
4
Meta
all smoke detector pef coa�).
This set of plans aM specifications MUST be
kept on the job a! all times and it is unlawful to
make any changes or altorations on samx-, without
written parmission from the Departmont of Pub6c
Works, County of eufto_.
U 0
M 4
0 Cul, Put fo'41�f e lo wt, 0 1, f
C'6
�)t)P�vp V)Pa'4
OW w0i'V4 A14" -vi
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G- UTTE COLJNP(
BUILDING DEPARTME-',F1'
A P P R 0 V E D
N1 alir,) or -f' 1� I-)tv. Aah'/ -1-o r�) t- I
,
t* 1Z 0 f-'4 SOS''
o", 1 t/q Ott, cir� 4 c 6-