HomeMy WebLinkAbout071-160-026COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, Oioville, 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.
1. I personally plan to. provide the major labor and materials for construction of
the proposed property improvement (yes or no) *�jcr5
2. I (have/have not) ,p - 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.
!+: I plan to provide, portions of this work, butI have hired the following person
to coordinate, supervise, and provide the major work:
Name
Address City
Phone Contractors*Lidense 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: C�
Property Owner
Socialecurity Number
Date .&4_4, 1193
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.
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.
(DI personally plan to provide the��or labor and materials for construction of the proposed
property imp °fiement : YES O' NO O
I HAVE 77 HAVE NOT 0 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: ,
J
NAME:
--
ADDRESS: CITY:
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
SIGNED: �1
PROPERTYOWNER:
SOCIAL SECURITY NUMBEMSS
DATE: o.vi o_ i g 07 R'
NOTE: ---- ---Thin-Owner-Builder Verification is required by Section 198.31 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.
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