HomeMy WebLinkAbout071-370-010COUNTY OF BUTTE - Department of Public Works
7 County Center -Drive, Oroville, CA 95965
OWNER -BUILDER VERIFICATION
Attention Property Owner:
Phone: 916-538-7541
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) �
2. I (have/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 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 L—
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
,19832 o.f 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.
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BUILDING DEPT
NAY 1 1 =
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BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
3 7,6 O /O (One Form Per Building)
Aa/
+,
School 'Distrct!`? Building Department No.
A.P. Number;_Jurisdiction (_J City 0� County
Property OwnerLKnb . rt ( -7 F /_bej
Property Location/Address
Subdivison
Residential Development
Commercial/Industrial
Buildin'fDepartmgfs Rep
No. of Living
Units
District Identification No.
Lot No
Sq. Footage
Addition (Group R)
Sq. Footage
New Addition
(Including Exterior
Roofed Areas)
S-/!- 9 Z
Date
�J`y.-;q_School District certifies that
(Applicant)
(Street. Address) (Phone Number)
(City) _ (State) (Zip Code)
has complied with the requirements of Resolution No.! by payment of $ 7'?0- 60
representing square feet.
School District Representative
Paid by Check Number ( Remarks:
Bank Number
Paid by Cash
//- 9�
Date
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee
Certification Form, the School District is notified by the applicable Local Planning Agency that this project
is being 'Teviewed'under the California Environmental Quality Act (CEQA), this project may be subject to
additional school fees to fully mitigate its impact on the school district's schools.
White (appiicant'). Yellow (building department), Pink (school district) feeform.wkf (4/92)
COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, 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.
1. I personally plan to provide the major labor and materials for construction of
the proposed property improvement'(yes or no)��_.
C2. I (have/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
4.
Address City
Phone Contractors License No.
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 Owner4 _ Pe��
Social Security N tuber .
Date /" 1�— c� U
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.