HomeMy WebLinkAbout071-390-012;
--
COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, Oroville, CA 95965 Phone: 916-534-4541
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/%4ve--m&t) 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 /y4" A457
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 411 !A1:
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
/#12o 4 13ze
Signed: ,
Property Owner
Social Security Number —
Date 9— Y' JV4
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.
OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing your signiature,
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 persoAally plan, to provide the major labor and materials for construction of the proposed
property, ement : YE NO
2. I HA VE NOT 13 signed an application for a building permit for the proposed wort,.
3. I have contracted with the following person (firm) to provide the proposed construction:.
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
4. I plan to provide portions of this work, but I have hired the follow'ing person to coordinate;
supervise, and provide the major work:
NAME:
PHONE: CONTRACTOR'S LICENSE NO.
5. I will provide some of the work but I have contracted (hired) the following persons to prgvide
the work indicated:
NAME ADDRESS PHONE TYPE OF WORK
SIGNED:
PROPERTYOWNER:
SOCIAL SECURITY NUMBER
DATE:. /&-I /D --G 9
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
i
RCv�StioNa.
U0
' of -\IE I
DESRmnom
-tovCC> k,o'3\L.V_ liomc-
I AA M
ARD , S,_OCtt TZU i �407Cii.
•rK%+46� .-*r.' 5%4c -e t t,.o
z o;r\o