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072-570-017
COUNTY•OF BUTTE -" Department of Development Services Building Division Oroville: 7 County Center Dr., Oroville CA 95965 Ph: 916-538-7541 Chico: 1469 Humboldt Rd., Chico CA 95928 Ph: 916-891-2751 COB DO BUTTENo OWNER-BUILDER VERIFICATION u i. 17 1994 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 plain toyprovide the major labor and materials for construction of the proposed property improvement (yes or no)— -- - 2. I (have/have not) JYA 05' signed an application for a building permit for the proposed work. C I have contracted with the Name s Address Phone 4. I plan to provide portions of provide the major work: Name Address Phone to provide the proposed construction: City Contractor's License No. , but I have hired the following person to coordinate, supervise, and Contractor's License No. 5. I will provide some of the work but I Nave contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work M Signed: Property Owner Social Security ] Date / Q . 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 permitted to issue the permit. ,1�,# oda- 2loo-iii Zud Sl COUNTY OF BUTTE - Department 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 and materials for construction of the proposed property improvement (yes or no) 2. I (have/have not) signed an application for a building permit for the proposed w rk. 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 Secur*ty. Nu ber 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. . � �� ' Ke o io 0PN �� � � � ���'' � ^"" " . Sec��on 2�-8,l �nf �he Du��e Coun�y Code� ' roquirey Lhia ucknowleduemenL be ded . �' . . /� 7he properLy Jeacrib�d xerein ia adjacen� ' ' \o lond uc included wi�hio an area znned [or a8riculLurul p ea uod reoiden�a ' ",�v� , ----- _� , u[ Lhia properLy may be aubjec� �o incou- �------- ---�� veniencey or diycomfor� ariain8 �rom Lho � uee o1 a8riculturuL �hemicaIa, iucludio8, � buL nu� ]imited �o bitideo' pe��icidee, und fer�ilizero; ao�� � �rmn �he puroui� | �{ a8ricul�urul npera�iona includio8, \ ' � 1but noL limiLed �0 cul�ivuLioo, plowin8 ' � � , \ aprayinA. prunin�, und harveatiu& ohich ` n�cuaiunally �eneraLe dua�. amoke, ooiae, aod oi or' Bu��e Coun�y haa ee�ohlie|`,J u�,i'�v |- Lurul zonea wbicb have ua a priori�y uoe for produc�ive u8ricul�uru| purpuaee' ooJ roxi'\,x\ , wi chin �saiJ �onea und adjecen� p�oper�y ahould be prepared Lo uccepL aud� ionmvn/invr or discnn[onn frum no�mul, oeceaaa�y [arm oyera�iouo' � | � All Lhat real proy�rLy . ai�ua�e in �he County of Bm�Le, S�aie o� Colitorniu, Jrxrri |"`'| '�, [oilovu' ' � ` / �� SE� E�BIBI� "�" B�R��) &0D�U�� �I�B� B�8�O� �� I��� [�SCRI��O0 � . � � / � � . � � . uaLe; ' . OWN�RS� S�a�e of Oo Lbia the day �� �� l0oo k,[or,` m, )3q'. �be underaig ry 9ubli red^�^--� ' Coun�y of ' '' i `� ' � . � COUNTY OF BUTTE - Department 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 and materials for construction of the proposed property improvement (yes or 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 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. S:rIy.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 -Z�� Social Securit umber .— Date 6�-=—.:!� 0 • ,SS NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. 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