HomeMy WebLinkAbout071-390-026I OWNER -BUILDER VERIFICATION -I
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing your
Please complete and return this information at your earliest opportunity to avoid unnec
in processing and issuing your building permit. No building permit will be issued until $is
verification is received.
I personally plan to provide the major labor and materials for construction of the proposed:
propertyFntracted
rovement : YES( NO '
I HAVHAVE NOT o signed an application for a building t for the
8n PP ' g P� proposed ago
3. I have c with the following person (firm) to provide the proposed construction; f :•.
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'coo '
Won ck .•
supervise, and provide the major work: T.:
NAME: .
ADDRESS: CIZy•
PHONE:
CONTRACTOR'S LICENSE NO. '
5. I will provide some of the work but I have contracted (hired) the following persons to pY+pvi�de
the work indicated:
NAME ADDRESS PHONE TYPE OF WORK
SIGNED:
PROPERTYOWNER:
SOCIAL SECURITY 1
DATE: .---1
--T
NOTE: This Owner -Builder Verification is required by Section 19831 and 19832 of
California Health and Safety Code. This verification must he 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)
IDEQr' n A11
School District V (I G. Building Department No.
A.P. Number —o —� Ya Jurisdiction: City r County
Property Owner � CaJ I �o 1
Property Location/Addres's r �i i_
Q � 1 /
Subdivision ��4� �S�T!/ C S Lot No. JO
................................................................................................
L144
Residential Development Sq. Footage
No of Living Mobi a oma Addition/ Supplemental to (Gro p R)
Units Installation Conversion Permit #
'(No foundation inspection):
:............................................................................... g
Co ercial/Industrial Sq Footage
New ddition (Including Exterior
^ `< Roofed Areas)
r fi
Building Department Representative Date
(moor runs reviewea Dy scnooi uistnct rersonnei)
,0032 District Identification No.
School District certifies that
(Applicant)
Cub ar7t.te-, �, - q 2s
(Street Address)
(City)
has complied with the requirements of Resolution No.
representing4.�,..� square feet.
Representative
(State)
(Phone Number)
" Y 7—•
„_ (Zip Code)
/�
by Payment !q 3512.
of $
AB 2926
$ i
FULL MITIGATION
$ j.
Date
Paid by Check # Remarks:V�
Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with
Government Code Section 66020(a), within 90 days from the date fees are paid. Failure to submit a timely written protest will prohibit
you from challenging the imposition of the fees in any court action.
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the Scholl District Is
notified by the applicable Local'Planning Agency that this project is being reviewed under the California Environmental Quality Act (CEQAL
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) feeform:xis (10/98)dmm