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BUTTE COUNTY SCHOOL'S IMPACT FEE CERTIFICATION FORM.
(One form per Building)
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School District 4::>2 eD V i t. L E L.. e -m Building Department No.
A.P. Number *--1%-,2 • t5 Co::' :) %=Jurisdiction: City
�✓ County
PO a)- l to O fo
Property Owner r'I2 C- E ---y A .,1 O
Property Location/Address Z C
IDA V i � ®►J
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Subdivision
Lot No.
Residential Development Q
......»
Q
..... »... _.».._.....
0
._......................... :... __... _..... ........... _-_
Q
, 894 -
':. Sq. Footage
No of Living
Mobile Home
Addition/
*Supplemental to
(Group R)
Units
Installation =
Conversion
Permit #
.....................»....................................»........
-(No foundation inspection) ..-J
i
Deed Restricted Sq. Footage
(Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document)
Commercial/Industrial Q
Q
Sq. Footage
New
Addition
(Including Exterior
Roofed Areas)
�..,.. ~
Bujklnlj Department Representative
Date '
District Identification, No.
School District certifies that F—Y e e_ 6-11 C
(Applicant) ,
Y
(Street Address) (Phone Number)
(City) (State) (Zip Code)
has complied with the requirements of Resolution No. �} �d �{.— `(. by payment of $ �� h Ems -
p
representing `. square feet. 2926 $
FULL MRIGATION $
o�
School District Representative Date
Paid by Check # Remarks:
Nods :You may protest the Imposition of the fats Identified above. by submitting a written protest to the DlstAct, in compliancewith
Govons wd Cade Section 66020(a), within 90 days from the date hes esti paid. Failure to submit a timely written protest wlli'prohlblt
you from challenging the Imposition of the fess In any court action.
if. subsequent to the School District Representative signing this Butte County Schools Impact Fes Certification Form, the School District Is
nodflsd by tit spplkab1 Local Planning Agency that thio proiect Is being re -le wd under the Calftimin Environmental Quality Act (CEOft
tlhb pro(eet may be sub)tet to additional school fees to hdly rdtlpaI As Impact on the school district's schools.
White (applicant), Yellow (building department), Pink (school district) • feeform-ads,00/031dmm
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COUNTY OF BUTTE - peparttnent of Public Works
7 County Center Drive, Oroville, 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 an4 materials for construction of
the proposed property improvement (yes or no) V PS
2. I (have/have not) U 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:
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, supervise, and provide the major work:
Name
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
Signed: .
Property Owner
Social Security Numb r ��/.- -
Date Date
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.