HomeMy WebLinkAbout071-390-021O.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 X NO ❑
2. '1 HAVE k 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: 58q ;a 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: � � J�
PROPERTYOWNER:
SOCIAL SECURITY NUMBER: �
DATE://— 2—
NOTE.
'OTE: 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 IMPACT FEE CERTIFICATION FORM
(One form per Building)
`Schoolpfstrict �i VY t Building Department No.
A.P. Number 0-1'1 .'2Q1, _ b-; Jurisdiction: City County
Properly Owner
Property Location/Address
Subdivision
Residential Development Q
Q
No of Living
Mobile Home
Units
Installation
Commercial/Industrial Q Q
New Addltbn
Building Department Representati e
District Identification No. _
S�
(Street Address)
Lot No.
LuSq. Footage
dation/ *Supplemental to (Group )
Co version rmit #
•(No foundation inspection)
.................................................................... ...................._....
Deed Restricted Sq. Footage
(Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document)
040116
r tT'C School District certifies that
Sq. Footage
(Including Exterior
RoofedAreas)
Date
5 '
e
(Applicant)
5.8 --IS`a ci5
(Phone Number)
k 10—T I v
(/Sttat/e)� q (Zip Code) �(rJ
has complied with the requirements of Resolution No. / L/J / by payment of $
representing square feet. 2926
FULL MMIGAN2=
School District Representative Date
Paid by Check # Remarks:
Notts: You may protist On Imposition of the Nes Went! aboveby submitting a written protest to the Dleftim in complWrw with
Govenwrmg Cods Section 66020(a), wltidn 90 days from the dater Nes are paid. Failure to submk a timsly written protist wltl'prohU*
you from ehailsr Mill the Imposition of the Nes in any court action.
M, subsequent to the School District Representative sip *V this dupe County Schools Impact Fee Cortiflallon Form, the School Dista .Is
ndWad by the applicable Local Planning /Agency that this project lsbeing rWewsd under the Cailfomla Envhon r ental Quality Act (CEQA),
this project may be subject to additional school Nes to fully mltlpah, its impact on the school dishietti schools.
White (applicant), Yellow (building department), Pink (school district) festorm.* (10/03)dmm