HomeMy WebLinkAbout072-240-004H.C.D.
ATTACH CHECK
NAW:
AN: � 7 � • �4-c� • aa4-
DATE: s �" �Q-
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 ro erty improvement: YES] NO[ ]. * . '
I 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 propose_ d
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:
NAINlE ADDRESS PHONE TYPE OF WORK
SIGNED:
PROPERTY OWNER:%zz,��
SOCIAL SECURITY NUMBER:
DATE: 3
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.
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 issuingyour 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: YDS[ ] NO( ].
2. I HAVE[ ] HAVE NOT[ ] signed an application for a building permit for the
proposes 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:
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:
PROPERTY OWNER• ,
• 1.
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.
May 1995 ► 2.26
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VIOLATION CHECK LIST
A. P. # 479•oR 90 Address Goo i=ors /dw" Ifel-'
Owner '
Owner's Address
.,Owner's Phone No. Supervisoral District
-Tenant's Name Phone No.
Type of Violation in Detail with Code Sec/tion Priority No. —
Mrd -i ce GIJ�D "Jv "y, T
0-77
Specific Plot Plan with C/V Noted _yes no -Penalties Required
lst. Notice Sent G A 2-- 2nd. Notice Sent �1-
-kate Date
Comments and/or Determination
fl
/ L4 c l QO ALJ
Disposition For Citation Citation
Date (Date)
Department Recommendation to Court
Court Action
Notice of Violation Recorded
(Date)
VIOLATION CHECK LIST
A.P. # a7a•,7A1-o-6 0iil Address 4a0 rorIx- s focv" &5� &
Owner ,,,c.�a Pe,
Owner's Address D6
Owner's Phone No. Supervisoral District
Tenant's Name Phone No.
Type of Violation in Detail with Code Secy/tion Priority No. 77
�JCc Y' ►�J a O 7I
Specific Plot Plan with C/V Noted _yes no Penalties Required
1st. Notice Sent G :z 1-- �S'J 2nd. Notice Sent �—
(Date) Date
Comments //and/or Determination
l
Disposition For Citation Citation
Department Recommendation to Court Date (Date)
Court Action
Noeice of Violation Recorded
(Date)
9
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 the
proposed work.
3. I have contracted with the' following person (firm) to provide the proposed
NAME:
ADDRESS:
pHONE;e�O�Z_/ g S J CONTRACTOR'S LICEN E 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:
NAl1IE:
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 PHON7E TYPE Or WORK
SIGNED: _.
PROPERTY OWNER:
Pal",,. - --�•• yr ; art •
01
DATE: (O
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.
,