HomeMy WebLinkAbout071-360-024O.B.- I
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 k NO ❑
2. I HAVE 9k HAVE NOT ❑ 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: 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:
PROPERTYOWNER:
SOCIAL SECURITY NUMBER: .
DATE: 1 7 O Z
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.
OVER
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BUTTE COUNTY SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM
e Form per-EZ'Ilding) G` oO�
A. P. Number `v G*O—WL/Building Department No.
School District neo o AA(& N City r__1 County Jurisdiction
Property Owner
Project Location/Address e ZX
I
Subdivision Lot Number
Residential Development:
a Sq. Footage Soo
# of Living MHI Addition (Group R)
Units
Commercial/Industrial: a Sq. Footage
New. Addition (Including.Exterior
Roofed( Areas)
VA4ky- �� ) C . 7--9-
Building Department Representative Date
(Floor Plans.reviewed°•by School District Personnel)
Dinct Id No. 9 2 0 2 6.7 ,
Qf� School District certifies that
(Applicant Nam ) (Phone Number)
reet Addres
(City) (State) (Zip Code)
has complied with the requirements of Resolution No.
by the p $/,qlp¢.6d OQQ square feet.
9chool Dis rict Representative, to
PAID BY CHECK NO. REMARKS:
BANK NO
PAID BY CASH
white -applicant, yellow -building department, pink -'school district
SCHOOL.FEE (8/88)