HomeMy WebLinkAbout069-180-023COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, Oroville, CA 95965
OWNER -BUILDER VERIFICATION
Attention Property Owner:
Phone: 916-538-7541
An "oi7ner-builder" building permit has been applied for.in your name andbearing
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 mateials 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 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 tb 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: I . . . -. . .....
Property Owner zli (z
Social Security ber
Date 7 22
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
19.832 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.