HomeMy WebLinkAbout071-390-010COUNTY OF BUTTE - Department of .Public Works
7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541
COUNTY OF BUTTE
OWNER -BUILDER VERIFICATION: BU1LDING DEPT
SEP
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 ear?iest oppo�it��y�o�"avoid
unnecessary{ delay,,inF.processingand issung�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) ' F\1 4n_.
2. I (have/have not) t mz-q,/ 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 UCity
Phone Contractors License No.
4: I plan to provide, portions of this ti-,ork, .but' I have hired' the following person
to coordinate, s per ise, anprovide t e major work:
Name �"
Address P� City G
Phone _(7 -5 Contractors' License No: ' O
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 Securit Number -
Date- �5
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.
COUNTY OF BUTTE - Department of Public Works
7 County Center Drive-, Oraville, 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)
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,upervise, and provide the major work:
Name 1JM MA 9-7A J
5.
Address I City
Phone Contractors License No.
I.will provide some of the work but I have contracted (hired) the following
persons to provide the work indicated:
Signed:
Property, Owner �.,,.
Social Securit Number -
Date ,q - l9 -69
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.
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BUTTE COUNTY SCHOOLS, IMPACT FEE CERTIFICATION FORM
0/0 (One Form Per Building) / Q/ _ D O Z
School District—eOn��h .--1 __— — Building Department No.
A.P. Number = gU --(2-/(? Jurisdiction �— J City County
Property Owner L.,G yz re iicc ��� �l_r��'L_ ,1.�� GG Aq I. 5
Property Location/Address 26-2 ---- —--_-.moi-N4.CZ_— &rrV
Subdivison
Residential Development
No. of Living MHI
COUNTY OF BUTTJ)nits
BUILDING DEPT
Commercial/Industrial JUL 2 7 1992 C�
New
Lot No.
0 Sq. Footage _
Addition (Group R) _
Sq. Footage
Addition
District Identificati
o
(Street Addgss)
(City)
(Floor Plans reviewed by School District Personnel)
(Including EXterior
Roofed Areas)
Date ' �4
in No.
Qlq*
ehool District certifies that
✓�� (Applicant)
has complied with theYee�quirirre/m�ents of Resolution No
representing square feet:
School District Represery ative
Paid by Check Number
Bank Number
Paid by Cash
(Phone Number)
(State) (Zip Code)
by payment of $
Remarks:
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 reviewed 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 (applicant), Yellow (building department), Pink (school district) feeformmkf (4/92)