HomeMy WebLinkAbout069-180-057
Attention Property Owner:
An "owner-builder" building permit has been applied for in your name and bearing your ;mv_
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 pro erty improvement: YESPq. NO[ ]. ✓
2. I HAVEV4 HAVE NOT[ ] signed an application for a building permit for the
proposedWork.
3. I have contracted with the following person (firm) to provide the proposed
construction:
NAME:
ADDRESS: CTI'Y•
PHONE: CONTRACTOR'S 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: CONTRACTOR'S 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
SOCIAL SECURITY NUMBER:
DATE:�D
NOTE: This owner -Builder Verification is required by Section 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.
COUNTY OF BUTTE - Department of Public Works
7 County Center Prive, 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 building permit. No building permit
will be issued until this verification is received.
I personally plan to provide the major labor and materials for construction of
the proposed property improvement (yes or no) �S
` ✓ I (have/have not) � v� signed an application for a building permit
✓✓✓✓ for the proposed w rk.
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 Security Number
Date Cf-- / �-- 2
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
-• 19832 of= -the California'Health and -Safety -Code. -
f
This verification'must be completed and returned to our office before we are per-
_ _ -.
witted to issue the permit.
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►t —fit Drive Oroville, California 95965
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