HomeMy WebLinkAbout069-430-02869-43-28
Albert Davis !� DAV__IS Albert. 2876B-
87 Skyline Way; Oroville ; 2324P
Permit # 1859-82B(reroof comp)SF 29 D
4-45-28_
069-430-028 ;'' 01.2971 158-Skyline Blvd., Oroville.
DAVIS, ANTHONY CONTR: John Voorhees, P.O.a Box 1
I 87 SKYLINE WY. OR ILLE Z (new, single family)
CONT: ARTIC AIRE
DUAL WALL HTR REPLACEMENT�-
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COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS _PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATIOICAND PERMIT
ASSESOR_ PARCEL NUMBER
La'-` x.
ZONING
I
BUILDING PERMIT
OWN
RI 0w I .
/S
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
OWNERtt''9' AILING ADD1RESSie `
__7
1 t
/
CONTRA TOR'SNA rE
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER�v!
UNKNOWN
Total Valuation is
Filing Fee
$ 1.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDIN DRESS
�'
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Repair drainage or vent piping
5.00
Water piping
LOT NO.
SUBDIVISION NAMEP
ARC EL MAP
Each qas water heater Or vent
5.00
Gas piping system 1 - 5 outlets
USE OF STRUCTURE
SFLA-, /
Duplex❑ Mobilehome❑ Other SPECIFY
Building sewer
Lawn sprinkler system
5.00
TYPE OF WORK
New ❑ Addition Remodel [,fes. Utilities ❑ Installations Other
Describe work: 0-&Yr.Z�I T
t 1n ' t /
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 101V OR 00 AMP ORLESS5.00
Main service EA. ADD'L 100 AMP
2.50
NEW CONST./DWELLING OCCUP.y)
OR ADDNS. ( ACC. BLDGS.
22 sq ft
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check One):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification
Q I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONSTR U LET 2.50 ea
NO N.RESID BRANCH CIRC TS
NEW CONSTR POWER APPARATUS 6
NON-RESID. (SINGLE OUTLET CIR.
500254
Ex. Occup(OUTLETS OR FIXTURES BAL@1
Ex. Occup.(OUT ETS (RESID )FIXED APPLNS REA. 2.00
Temporary service
10.00
Mobile Home Facilities 15.00
Misc. Wiring 7.50
Permit Fee $
Contractor
MECHANICAL PERMIT
FiIingFee 10.00
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Heating
Cooling
Hood
3.00
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
X Z" Date `
Signature `of Applicant — Owner ❑ Contractor � Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
,
TOTAL PERMIT FEE $
OCCUP. GROUP
I TYPE OF CONST.
PARCEL
PD
I ND I ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicate ve for which
IRE O � OF PUBLIC
_
BY
PERMIT EXPIRES Dat
the applicable provi-
resolutions to do
fees have been aid.
P
WORKS
Date
�'
Receipt No. 7��
WHITE-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT
a".k^�S�.Y"* ""„r'"' 4'^r�r.w� �_ .`-a+an-anr *.ss �- -a>• -x.� r •u=r- _ _„�,cy, ., �;: �,��9.' � ..; ..., -,ey --, Wit: v.i�P "•��+sF.zc»v�.,...v,.. ._ �, �, ,..d.
069-430-028 01-2971
DAVIS, ANTHONY
87 SKYLINE WY. OROVILLE
` CONT: ARTIC AIRE
DUAL WALL HTR REPLACEMENT
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT 01-2971
ASSESSOR PARCEL NUMBER
U69-430-026'VTELEPHONE
ZONING
BUILDING PERMIT
OWNER
AKIWA IS
SO. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
WA
CONTRACTOR'S NAME
TELEPHONE
CONTRACTORS MAILING ADDRESS
2350 PARK AVE.. .y ' IA) LA 951928
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee $ 20.00
Permit Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
Energy Plan Checking Fee $
$
PERMIT FEE $
LOT NO.
SUBDIVISIONS NAME
PARCk MAP
PLUMBING PERMIT Fling Fee 20.00
Each Trap 7.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other
SPECIFY
Solar or heat pump water heater 23.00
Water piping 15.00
Each gas water heater or vent 15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: DUAL. WAU RATER REnAC);M9:fifT j
Gas piping system 1 - 5 outlets 15.00
Building sewer 15.00
Mobile Home I S I G I W @20.00
PERMIT FEE $
ELECTRICAL PERMIT Fling Fee 20.00
600V LES
Main Service 2o..OR LESS 23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provision of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect. j
License Class ' Lic. No. T. "1 !
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason: I
❑ I, as owner of the property, or my employees with wages as their sole coiTipensation,
will do the work, and the structure is not intended or offered for salt.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. !
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:,
❑' 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
Policy Number j +. °� ( `, .� J _ .'
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
X �+ �--•-- Date J ' _ _
Signature of Applicant - ❑ Owner ❑ Contractor q Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Main Service 200A To I000A 46.00
NEW CONST. DWELLING OCCUR s0
( 3.5¢FT:
N�
cad MUAicrcoue+os.
NON-RESID. 97.50
POWER APPARATUS
8 SINGLE OUTLET CIS.
Ex. Occup. ourLETORFocruREs BAL @ 1.50
.
Ex. Occup.ouTETsFlXEDAPPRESLNSID. OR EA 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE S
MECHANICAL PERMIT Fling Fee 20.00
Heating 1 15. 00 15.00
Cooling
Hood 6.50
Ventilation
PERMIT FEt $ •
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE
TOTAL FEE $ 35•W
HAZ.
t FEES
IMP
I FLOOD
I CDF
PARCEL
PD
NO
I ISSUE
This permit is hereby issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
indicated Pbove for which fees have been paid.
r y� ,�
By Date 1�2�-1iJl)�
PERMIT EXPIRES ON 11^ter (;—e C,'L
I Dere
Receipt No. 33 141
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • OroviNe, California 95965 • Telephone (530) 538-7541 PERMIT NO.
(Rev. 12/96) APPLICATION AND PERMIT 01-2971
ASSESSOR PARCEL NUMBER
069-430-028
ZONING
BUILDING PERMIT
OWNER
AMONY DAVIS
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
87 SKYLINE WAY DROVITI.E.
CONTRACTOR'S NAME
TELEPHONE
CONTRACTORS MAILING ADDRESS
2350 PARK AVE-, 04M CA 9992A
CONSTRUCTION LENDER
Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
Filing Fee
$ 20.00
Permit Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDINGADDRESS
87 SIM INE WAY ORWILLE
Energy Plan Checking Fee
$
$
PERMIT FEE
$
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Fling Fee 20.00
Each Trap
7.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other
SPECIFY
Solar or heat pump water heater
23.00
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑
Describe Work: DUAL WALL HEATER REPLACEMM
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home IS I GI W1
@20.00
PERMIT FEE
S
ELECTRICAL PERMIT
Fling Fee 20.00
R LESS
Main Service 2a.A OR LESS
23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is' full force and effect.
License Class I C. -2G C -b Lic. No. ��� 3
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
I her y affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier YV\ p 1S
Policy Number all • S - I X41 L PA,,w n !; c%S
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
�
X Date"zI
Signature of Applicant - ❑ Owner 0 Contractor gA4ent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
TO
Main Service 200A 1000A
46.00
NEW CONST. DWELLING OCCUP. CU SO
OR ADONS. ( d ACC. SUDS. 3.50FT:
NON-REOSIU MULTI -OUTLET
@7.50
WER APPARATLIS
8 BINDLEE OUTLET CIR.
�(, OCCU OUTLET OR FDTTURES
20 1.0
B @ 0
Ex. Occup. oui�Ds A IESIEs o �ea 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE $
MECHANICAL PERMIT Fling Fee 20.00
Heating 1 5.00 15.00
Cooling
Hood 6.50
Ventilation
PERMIT FEi_ $ 35.00
Mobile Home Installation Fee $
Energy Inspection Fee $
Occ
CONST. TYPE
TOTAL FEE $ 35.00
FEES IMP I
FLOOD
I CDF
PARCEL
PD I HD:n
This permit is hereby issued under
of the Butte County Code and/or
indicated bove for whit shave
y
PERMIT EXPIRES ON 11-20-2002
the applicable provisions
Resolutions to do work
been paid.
Date 11-20-2001
Date
ReceiptNo. 337141
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
7 County Center Drive • Oroville, California 95965 •Telephone (530) 538-7541
(RASSESS RP APPLICATION AND PERMIT _ Z PERMIT NO
Assessoq PARCEL w�ea
OWNER
C7— V1 BUILDING PERMIT
*aoNONe EA9 SO FT,OCC.
BUILDING VALUATION
OWNMAlJNO �D t � ,N 1�
CONTRACTOR'! ' Y t
TEL1P c
I V' 8
CONTRACTOg7 ADDRESSI'
CONSTAUCTiON LEWD EA vie. -�/e/�
N S/
LENDER s LtHUNO ADORE°t Fire Ince
ARCHITECT ORE"MWEA UCEF4E WO. Total Valuatlon S
S
♦gCIfTECT OR ENONlEAg wwNo ADORES! Filin Fee 20 00 Permit Fee =
SUUMOaooREss Plan Checkin Fee S
Energy Plan Checking Fee i
S
.OTNO sueDivecNSNAYE PARCEL MAP PERMIT FEE S
PLUMBING PERMIT Fling Fee 20.00
USEOFSTRUCTURE Each Trap 7.00
Solar or hent um water heater 23.00
SF ❑ Duplex O Mobilehome O Other Water i in
t�� W 15.00
TYPE OF WORK Each as water heater or vent 15.00
New ❑ Addition O Remodel O Utilities O Installs O Other O Gas piping system 1 - 5 outlets 15.00
j
Building sewer 15.00
Describe Work: �(aC_ ��/A!I��� ,e P- Mobile Home S G W @20.00
PERMIT FEE S
ELECTRICAL PERMIT Filln Fee 20.00
Mein Service 20.0AOR LESS 23.00
Main Service 20" TO 1000A 48.00
NEW CONST, MR - NO OCCUP
OR AOONs. a ACC. KOS. 3.501.
NON.AESiO. VulnoIRLET
@7.50
*PER -rT FEE PAXb
SRA • •
SHERIFF
OTHER
AMOVNT RECEZVEb
"RECEIPT NVAWM s� 3 `71 i
* TO 0E PVT 2mm comm
EX. Occup. OUTLET OR FIXTURE! 20 O 1.00
Ex. OCCU iC(EO �' OR
SAL .00
ovnM Esso. Ew 5.00
TemporaryTe-porary Service 23.00
Mobile Home Facilities 20.00
Misc. Wiring 23.00
PERMIT FEE I t
MECHANICAL PERMIT Fling Fee 20.00
Heating u> w
0
C OOIin
Hood 8.50
PERMIT FEi: 1 2
Mobile Home Installation Fee $
Energy Inspection Fee is
Occ CONST. TMOE TOTAL FEE _
�� c4
NAZ D. FtE9 wP ;1 007cDR PARCQ I PD I mo 1 —4
This permit is hereby Issued under the applicable provisions
of the Butte County Code and/or Resolutions to do work
Indicated above for which tees have been paid.
By
PERMIT EXPIRES ON
Date
COUNTY OF BUTTE - DEPARTMENT OF PUBLICWOR S PERMIT NO.
7 County Center Drive - Orovilie, California 95965 - �Tetepr)6%e 916/ 4-4541
APPLICATION AN6 PERMIT
ASSES�OR PARCEL NUMBER
,r
ZONING
BUILDING PERMIT
OWN
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
ER'S AILING ADDRESS
FC
rO
N RACTOR'S NA
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER ^ _
UNKNOWN
Total Valuation $
Filing Fee
$ 10,00
LENDER'S MAILING ADDRESS
Permit Fee
$Ac,.,nrl
ARCHITECT OR ENGINEERLICENSE
`b
No.
Plan Checking Fee
$ "
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$ ,
BUILDIN DRESS
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Repair drainage or vent piping
5.00
Water piping
LOT NO.
SUBDIVISION NAMEPARCEL MAP
Each qas water heater or vent
5,00
Gas piping system 1 - 5 outlets
USE OF STRUCTURE
SF Duplex❑ Mobilehome❑ Other
SPECIFY
Building sewer
Lawn sprinkler system
5.00
TYPE OF WORK
New ❑ AdditionRemodel Utilities ❑ Installation bther
Describe work: e—
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 100V OR LESS
100 AMP OR LESS
5.00
Main service EA. ADO'L 100 AMP
2.50
NEW CONST. ( DWELLING OCCUP..)
OR ADDNS. ACC. BLDGS.
l 22 sq ft
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Businessso@2N
and Professions Code and m license is in full force and effect.
License No. Classification y
I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONSTR I-ou LET 2.50 ea
NON.RESID BRANCH CIRC ITS
NEW CONSTR I POWER APPARATUS 61
NON-RESID. ISINGLE .OUTLET CIR. /
Ex. Occup(OUTLETS OR FIXTURES BAL@1
Ex. OCcup.(OUT ETS PIXED P(RESID.)REA. 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 7.50
Permit Fee
$
Contractor
MECHANICAL PERMIT
FiIingFee 10.00'
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
ftt 1 shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: if after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwitn comply with such
provisions or this permit shall be deemed revoked.
Heating
Cooling
Hood
3.00
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
agains id C sequ of the granting of this permit.
X �"� Date 7 � � 7� /�
Signature of Applicant'— Owner Contractor Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures stories in height.
Mobile Home Installation Fee $
TOTAL PERMIT FEE $
OCCUP. GROUP
I TYPE OF CONST.
PARCEL
PD
I NoI
ISSUE
This permit is hereby issued under
sions the Butte County Code and/or
work indicated ve for which
IRE O F PUBLIC
By.
PERMIT EXPIRES Dat
the applicable provi-
of
resolutions to do
fees have been paid.
WORKS
Date
pover
G3
Receipt No. 4 4t !��c
WHITE-D.P.W., YELLOW -ASSESSOR. PINK -INSPECTOR. GOLDENROD -APPLICANT
COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, Oroville, CA. 95965 Phone: 916-534-4541
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 in the envelope provided at your
earliest opportunity to avoid unnecessary delay in processing and issuing your build-
ing 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)�T.
2. I (have/have not) signed an application for a building
perLe�contracted
he pr sed work.
3. I h with the following person (firm) to provide the proposed
con:
Nam
Addless City
Pho a Contractors License No.
4.• Ilan to provide portions of this work, but I have hired the following
p son to coordinate, supervise, and provide the major work:
ress City
ne Contractors License No.
5. will provide.some of the work but I have contracted (hired) the following
pe sons to provide the work indicated:
Name Address Phone Type of Work
S
iea :
Property Owne
Social Securi
Date '7-- 9
FRAO
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
permitted to issue the permit.