HomeMy WebLinkAbout069-180-041
COUNTY OF BUTTE-:D.epartment 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 issu.ing.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) ,y'w
2. I (have/have not) /v -,a 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. J plan to provide portions of this work, but I have hired the following person
to coordinate, supervise, and provide the major work:
Name n/r,> ,. C
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
Ala, .✓
Signed:
Property Owner La. -
Social Security Number
Date y -o — 6,41
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.
� r
M►, as 4_ a`
BUTTE COUNTY SCHOOLS DEVELOPMENT FEE,CERTIFICATION FORM`
(One Form Der Erdilding)
A.P. Number "7 / Building Department No.
,. j
School Districtcl) -E%eM City Q County 12 �iurisdiction
Property "Owner VA)a u A. --e n -� .! fns , 4, i� -� n �-A.
0 2 ����
Project Location/Address 7 Men 1 n 'f • t o S w
Subdivision
Lot Number
Residential Development: a
[;?0- Sq. Footage
# of Living MHI Addition (Group R)
Units
Commercial/Industrial: Sq. Footage
New Addition (Including Exterior
Roofed Areas)
Building Dep V
tment Representative Dat
District Id No. 6ar?'.Q
School District certifies that
(Applicant Name) (Phone Number)
(S� t Address)
(City) (State) (Zip vCode)
has complied with the requirements of Resolution No.
by the payment of $ o7U/!o ov representing feet.
School DiS r ct Representative Date
PAID BY CHECK NO.
BANK NO
PAID BY CASH
REMARKS:
white-applicant,,.y.q,l,low-building department, pink -school district
SCHOOL. FEE,