HomeMy WebLinkAbout071-390-039couffry of rtM15-7
BUILDING DEPT
.; J U L 7 1995
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[ ] NO[ ].
2. -I HAVE[ ] HAVE NOT[ ] signed an application for a building permit for :he
proposed work
3. I have contracted with the following person (firm) to. provide the proposed
construction:
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
coordinate, supervise, and provide the major work:
NAME: BIZ- `
ADDRESS: Z/. -I -7, -o91 -_-1,e6 RL CITY:
PHONE: 3 !„l CONTRACTOR'S LICENSE NO. M71:71
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:���
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.
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-Attention Property Owner.
.
• An "owner -budder" 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 budding permit No budding 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 ro erty improvement : YES" NO[ I.
2. I HAVE HAVE NOT[ ] signed an application for a building permit for the
proposed work-
3.
ork3. I have contracted with the following person (firm) to provide the proposed
construction:
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
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:
NAIMM ADDRESS PHONE TYPE OF WORK
SIGNED: /
PROPERTY OWNER:
SOCIAL SECURITY NUMBER: ` �
DATE:
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.
BUTTE COUNTY SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM
One FQrm'p;r Building) /O/....
P. Number Iy/ Building Depairtment No.
School- District 11A1 city county Jurisdiction
Property Owner
Project Location/Address
Subdivision Lot NumberC"I
Re$idelVDID661lopment:
o Sq. Footage
111a / r_zJ_ 766
ofMHI Addition (.GrgUp
Li.,.yiLi7-
�s
- aCommercial /Industrial:
New
Sq. Footage
Addition (Including Exterior
Roofed Areas)
6 /-'� ;7A01—
Btilding Q,61T'rtment Representative Date
(Floor Plans reviewed 'bv'School` D& rict Personnel)
VV NA\
["District Id No.
'If$
App
?20273
ZA14 Al. Aha�
cant Name)
S Addr
,reet _i� ?.E
(City)
has complied with the r1q
by the paWnent of $
001- Vistric
A
0 hool District certifies that
c )WG. 41st 697 -0 AP
L.L. W11,
(Phorfe-Number)
(State) (Zip Code)
� �
quirements of Resolution No. 106 YO
O, O0 " representing / 700squarefeet.
epresentative ate
PAID BY CHECK NO. REMARKS:
BANK NO
PAID BY CASH
r.
white -applicant, yellow -building departr.qent, pink -school district
SCHOOL.FEE (8/88)
t