HomeMy WebLinkAbout071-150-020OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing your signatt re.
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 NO ❑
2. I HAVE ❑ HAVE NOT ❑ signed an application for a building permit for the proposed wofk,
3. I have contracted with the following person (firm) to provide the proposed construction:. ; s:
N ♦ \TE. --
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
1
SIGNED:
PROPERTYOWNER:
SOCIAL SECURITY tMBER:_
DATE:
NOTE: --- This Owner -Builder Verification is required by Section 198.1x1 and 19831 of de
California Health and Safety Code. This verification must be completed and
returned to our office before we are permitted to issue the permit.
OVER
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.
a
1. I personally plan to provide the major labor and materials for construction of the proposed
property improvement : YES NO O
2• I HAVE 13 HAVE NOT 13 signed an application for a building permit for the proposed woik.
3. I have contracted with the following person (firm) to provide the proposed construction:
` ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO. r
4. 1 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 f
SIGNED:
PROPERTYOWNER:
DATE:
NOTE: ---- This -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..
OVER
/
S _
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 [>I< NO[ ]. _
2. 1.1 HAVE NOT[ ] signed an application for a building permit for the
proposed work.
3. 1- have contracted with- the following person (firm) to provide the proposed
GV110L1U%,L1V11. -
NAME: w�
ADDRESS: / 6S'v lF P- A--iiiti2 EWE CVn DQo Q i Lccf C!4 9- 5465
PHONE: 5-3-3 _ g1 21 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:
- PROPERTY OWNER:
SOCIAL SECURITY
DATE: 02
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.
May 199; 2.26
COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, Oroville, CA. 95965 Phone: 916-534-4541
OWNER -BUILDER VERIF ICAT ION
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)i2
S •
2. I (have/have not) G signed an application for a building
permit for the prop ed 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 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 n r. —
Date - C-�� ? z/
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.
COUNTY. ,OF;, BUTTE - Department of Public Works
7 County Center Drive, OforTille, CA. 95965 Phone: 916-534-4.541
OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing
your -signature.
a Please complete and return this information in the envelope provided at your
r 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.
J. I personally plan to provide the major labor and materials for construction
of the proposed,property improvement (yes or no)
2. I(have/have not)' c 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 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 : .D
Property Owner
Social Security number
Date
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.