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HomeMy WebLinkAbout073-410-022-RECORDING REQUESTED WY AND IMOd ItZCXMtCNM KAIL TO F -I K. - &VCinAY 54 - 399 S6,oloerij V-Ny j Wilt OFFICIAL RECORDS BUTTE COUNTY-CAIJF. i UC R.P S REQUESTED By J ��i 3 7- 1984 ,U -L AMA""F MIAMI m. ul ""r CLUM - REMX,4fi '9 � -1-24672 WE SPACZ AA30VE THIS UNIM FOR RECORDEWS USE DEED 0 F G.1 FT Mw Invorram made the S Ixth ----&Y of junp 12 R4 Bzrwmm Charles Kirk %itiano St"lay R_ 7jrinn- Wiliia. rdwa�rd 7irian. Connty,j But e —3taeof. Calitornia the partir, . ad do ant Past A,m - Stanle3; R, Zirion the part— of the swood pod. Wnwwwrn: 7ILat the part 3 a a of the first put far and in consideration -of the love and affect[= which the said part44s. of the first part hppe and bear— untD said pafty�_ of the second part, as -also for the better maintenance, support, protecti= and ' livelC &ood of said part-.*— of the second part dahepj�,,these presenta, give, grant allen and confirm. unto the said part -y— of the second part and to h 4 . heirs and assigns forever, all th certain lot.— piece or parcel— of land, situate, lying and being in the County of Butte --State of Cn 4foinnin and bounded and particularly described as follows. to�wft. Description attached Chang; of . hip U.Wmnl NOT 04k�. 6M. 4W It & T 10 ra S�," to maimI111 ad4rqm on dommm*- Tocriinta with all and singular the tenements. hereditaments and appurtenances thereunto bel'o-g'Ing, or in anr wise appertaining, and -the reversion and reversions. remal der and rem- I ders, rents, Ism, and profits thermE tm Wrmw Wmmeior, the said part i e 8 th 4 of the first part have hereunto hand 8 set and se&L— the day and year first above wriftm OFFICIAL SCAL R gq. =ICHARDD COSE�W rJOTARY PUBLIC - CALIFORNIA Y YUBA NTY UBA ODUNTY L ',� OVIICS AUG 211. 1987 Y4 A&IJ STAIM CW CALIFORNIA. on it re befog zne.,�FV,= N Pd& to and for said 023 "r St.be. P...6 PV Aduiu, CZ known to tow, wbose MAZIMIX to be the per—s- CM subscribed to Ow wi&n Lutrunient. and ackworlodged to me that executed the nutia 31� C" Wrrmm my how itaid offiew senJI. 046 Notiov PubUv is and for mad Seggg, r" Title Order 6 Escrow or 14an 0 CEO—owl—W Foom 774 I%b otood"d #aq, own" Mood probl'oo "1060 geld bd a. 0 to to 02 and suils cb—so, VmVw 0. a kWW& 1W bkodo, Wista, "S . . . a Uw 9 � doubt for row Purpo"t. 4L 4� THE DESCRIPTION OF THE MIDDLE ONE-THIRD OF 7HE PARCEL OF LAND DESCRIBED BY THE DEED RECORDW IN BOOK 1970 or OFFICIAL RECORDS AT PAGE 527, AuTTE couNTy RECORDS All that certatu'real property situate In the unincorporated area of. the County of Butte, State of California. described as follows: Being a portion of the Nort'heast oue-quarter of, the Southwest one-quarter of Section 2. Township 19 North' Range 7 East. Mount Diablo Base and Meridian and also being a portion of t� t certain parcel Of land conveyed to Charles Kirk Zlz�n, et al, on February 2g. 1975.by the Grant Deed recorded In Book 1970 of'oificial Records, at Page 527. In the Office of the Butte. County Recorder. said portion being -more Particularly described as follows: BEGINNING at a Point lying In the Southerly line of the Hart' one-quarter of the Southwest beast one-quarter of said Section 2 from which point -- the Southeast corner of the said Northeast one-quarter one-quarter bear# Easterly a distance of 21 of the Southwest 1.00 feet, said corner being the POINT OF BEGINNING of the above mentioned parcel described by the deed recorded In Book 1970 of Official Records, at Page 547. Butte County Records; thence from the said pour OF BEGINNING of the parcel herein. being described, run Westerly. along the Southerly line of tbe.siald Northeast one-quarter of the Southwest one-quarter of Section 2, a distance of 214.65 feet; thence leaving said Southerly line run North 02051'17' Is at, 237.21. feet to a point lying in the physically =Gnumuated Sou�cherly boundary line of that certain parcel of land conveyed to Max'F. Murphy. et ux, by the Grant Deed recorded In Book 1240 of Official Records at Page 460, to the Office at the Butte, County Recorder; thence North Si'58147" East. along the sold Southerly line of the said Murphy Parcel, 53-82 feet to 'an Iron pin. one-half Inch In diameter, tagged R.C.E. $938 and marking the Southeasterly corner thereof; thence North 02*59106" Went * along the Easterly boundary line at the said Murphy Parcel, 15*09 feet to appoint lying In the Southerly boundary line Of that certain parcel of land c nveyed to William Edward Straeban by the Grant Deed recorded In Book 19;0 Of Official Records at Page 5280 in the Office of the Butte County Recorder; thence Easterly. along the said Southerly line 'of the St' a distance of 162.46 feet; rachan Parcel, thence leaving said Southerly line run South 02'51'17- West, 257.65 feet to the POINT OF BEGINNING. ce cm The parcel described hereby contains 1.25 acres of land, more or less. ca C2 tOCETHER VITIR the right to Ingress and egress over -and across a strilp of land fifty feet In width$ being a right-of-way for road purposes and described In Parcel no. 3 of the Grant Deed recorded In'Book 1253 of Official Records at Page 4529 In the Office of the Butte County Recorder an follow*z BEGINNING at a 5/8" Iran pin that is South *38"24 111' West, 722.72 feet from the center of Section 2. Township 10 North, Range 7 -lasts M.D. B. & U.. Butte County, Califorzdq; thence South 2*51'17" Vest, 0� feet; thence North 85010"50' East, a' distance of 50 feei; thence North 02*521 Rant, a distance of 315 feet, more or less, to.& point at the Southwest corner of that certain property described in Deed from Edward K. Sirachan, et ax, to C. H. Gibbs, at ux, dated October 22. 1959 and recorded October 30, 1959 In Book. lOi5 of 'Official Recordst Page 245; t.hence North 2*51117" East, along the Westerly I ' ine of said Gibbs property and the Northerly extension thereof. a distance of 385 feet more or less, to a point on the Southerly line of the Marysville -LaPorte Road; thence Westerly, along the Southerly line of said Marysv111eLaPorte Road, a distance of 50 feet; thence Soutb.02*51117' Vest.. a distance of 220 feet to the POINT OF BEGINNING. NOTE: The bearings of the above description to be rotated 05*500W counter- clockwise to match the physically located boundary. lines. and the found monuaets which mark the various corners as Intended. RESERVING THEREFROM an easement for roadway and utility purposes over, under and across a strip of land fifty feet or more In width the bounds, a f which are described as follows: BEGINNING at the Northeasterly corner of the 1.25'scre parcel hereinabove described from which the Southeast corner of the said,Northeast onea-quarter of the Southwest one-quarter of said Section 2. also being the POINT OF BEGINNING of the above mentioned Charles Kirk Ziron, et al Parcet, described by the died recorded in Book 1970 of Official Records, at Page 5279 Butte County Records, bears the following two (2) consecutive courses: (1) South 02*51117' Went a distance of.257.65 feet; and (2) South 85010050" East a distance of 211.00 feet; thence from the said POINT OF BEGINNING run South 02*51*17' East. along the Easterly boundary line of the said bereinabova described parcel. a distance of 50.03 feet; thence leaving said Easterly line run Westerly, along a line measured 50.00 feet Southerly of. at right angles from and parallel with the Northerly - boundary line of . the said parcel, a distance of 13.40 feet; . thence South 88*58147' Went, 201.59 feet to a point lying In the Westerly boundary line of the said hereingbove described 1.25 acre parcel;. thence North 02*51117" East. along the said Westerly line. 50.11 feet to Northwesterly corner of the said parcel; 0, ca ..... . . . . . 9 1 5 5 G 3 ME<�� Afou"T'M By v 2-,z ORD" 0 AND WWM RECOMM IML TO Ken DaSalvo P.O. Box -157 Clippec MIlls, CA 95930 L MAIL TAX STATUREP(TS TO . F same as above cay a stow L Ape 073-33-0-092-0 M1 -ij --I 91--015503 Rec Fee 9.00 Cash 9.00 Recorded Official Records County or Butte Candace J. Grubbs Recorder 1217pa 22 -Apr -91 XX 3 SPACE ABOVE THIS LINE FOR FECOF&MrS USE Gift Deed TM FOM RAV41SMED 13T OMMUL TrTLE & ESCROW COMANY Documentary transfer tax is -0- ) computed on full value of property conveyed. or ) computed in full value less value of Hens and cocumbriam remaining at time of sale. ) Unincorporated area: City of and IN CONSIDERATION of the love and affectioc which die grantor(s) bc3r(s) to the grantWs I NICK DESALVO and THERESA L. DESALVO, husband and vife do (does) be -by give- F= and —cY to KEN DESALvO, as his sole and sepacate ,, pcopecty all that real property in LN-- City of unincocporated-acea of the Canary of Butte Sum of California. described as Please see attached foc legal descciption MAIL. 3AA b 1A1 tMtH US AS DIRECTED ABOVE . 7 Dated P 2 -- STATE OF CALIFORNIA. ss. COUNTY OF 2 --mc- M me rAL-0 On —DL�krl I -10 Icks % before me. the undersigned. a Notary Public in and for said State. personally appeared '-t), MCIA --i n Dt.;bal,vu Pe-3mmily knOWIT-M-ffm-forpraved to me on satisfactory evidence) to be the pcmnLs) whose narncw4wlare subscribed to the within instrument and acknowledged to me rj FFIECIA SF L that he 191- /they executed the same. -41, %�j IMINE WILDLIAMSON ?,ISOPO WITNESS my hand and official seal. GTASYRaUr- - CALIFOFO" N t SA�--RAL--NTO COUNTY J C� 4Y ca 17. 199, Signature Im hr%-, .Mzis L -m for official r"arial sW) MAIL. 3AA b 1A1 tMtH US AS DIRECTED ABOVE 9 1 15503 A 8 - 0 13 5V .TFIE DESCRIPTION OF THE MIDDLE ONE-THIRD OF THE PARCEL !)F T.A�m 2y n= R,�3 ;-, C,3,( , RZZ . ,, 3. 1970 0 OFFICIAL RECORDS AT PACE 527. BUTTE COUNTY RECORDS All that certain real property situate In the u nincorporated area of the County Of Butte, State of California, described as follows: Being a portion of the Northeast one-quarter of the Southwest on"aarter of section 2, Township 19 North. Range 7 East, Mount Diablo Base and Meridian and. also being a portion of that certain parcel of land conveyed to Chzrles Kirk ZiMn, et al. On February 28, 1975 by the Grant Deed recorded In Book 1970 of official Records, at Page 527, In the Office of the Butte County Recorder, said Portion being more particularly described as follows: At a Pt�Jnt lyini; in tie -Southerly line of the Northeast one-quarter of the Southwest one-quarter of said Section 2 from which point the Southeast corner of the said Northeast one-quarter of the Southwest one-quarter bears Easterly a distance of 211-00 feet. 'said corner being the POINT OF BEGINNING of the above mentioned parcel described by the deed recorded In Book 1970 of Official Records, at Page 527, Butte County Records; thence from the said Polar OF BEGINNING of the parcel herein betas dl!ccribcd, r.4 *wejierly, along the Southerly line of tb- said Northeast one-quarter of the Southwest one-quarter of Section 2, a alstance of 214.65 feet; thence leaving said Southeily line run North 02*51917- . East, 237.21 feet to a point lying In the physically monumented Southerly boundary line of that certalt. parcel of land conveyed to Max F. Murphy. et ux, by the Grant Deed recorded In Book 1240 of Official Records at Page 460, In the Office. of the Butte County Record_er_.-________--- thence North 88*58147- East, along the said Southerly line of the said Murphy Parcel, 53-82 feet t an Iron ping one-half Inch In diameter, tagged O.C.M. 8938 and marking the Scoutbeasterly corner thereof; thence North 02*59106- West, :31ong the Easterli L-aurdary 3ine of thp said ur phy Pareell. 15-09 feet to a point,lying In the Southerly boundary line of that certain parcel of land conveyed to Williac Edward Strachan by the Grant Deed recorded In Book 1970 of Official Records at Page 528. In the Office of the Butte County Reco_rTe—r—*.---------- -2 thence Easterly. along lae said. Southerly line of the Strachan Parcel, a dicten-e of 162.46 thence leaving said Southerly line run South 0 2*51*17- West, 257-65 feet to the POINT OF BEGINNING. The parcel described hereby contains 1.25 acres of -land, more or I ess. ria) A 0 3 0. LIS EL TOGETHER WITH the right to Ingress and egress -646i-a-M across of land fifty feet In width. bein*g a right-of-vay for road purposes and described In Parcel No. 3 of the Grant Deed recorded In Book 1253 of Official Records at Page 452, In the Office of the Butte County Recorder as follows: SiGIqNTNC at a 5/8- Iron via that is South 39-24'11- West. 722.72 feet from the center of Section 2. Township 19 North, Range 7 East, M*D. B. & M.0 Butte County, California; thence South 2*51'17- West, 475 feet; thence North 85'10'50" Cast. a distance of 50 feet; thence North 02*51' East, a distance. of 315 feet, more or less., to a point at the Southwest corner of that certadn property described In Deed from Edward K. Sirachan. et ux, to C. H. Gibbs. et ux. dated October 22. 1959 and recorded October 30, 1959 In Book 1025 of 'Official Records, Page 245; thence North 2*51'17- East, along the Westerly -the Northerly extension thereof, a distance of line of said Gibbs property 'and 385 feet more or less, to a point on the Southerly line of the Marysville -LaPorte Road; thence Westerly. along the Southerly line of said -�et; - West, a Macysville-La?crta.R-cad, a distance o_: 50 f thence South 01*51'17 distance of 220 feet to the POINT OF BEGINNING. NOTE: The.bear!ngs of zhe above des::r1p-LIvz- tu im clockwise to match the physically located boundary lines and the found "numets wbich mark the various corners as Intended. RESERVING TF[EREFROM an easement for roadway and utility purposed over. under and acro. -;z a strip of land fifty feet or more In width the bounds of which are described as follows: BSCIN-NINZ aL the NortheasterI7 ccrrer of. the 1-25 3cre parcel hereInabove describeA :rom which the SouXheast corner of the said.Northeast one-quarter of the -Southwest one-quarter of said Section 2, also being the POINT OF BEGINNING of the above mentioned Charles Kirk Ziron, et al Parcel, described by the deed recorded In Book 1970 of Official Records, at Page 527. Butte County Records. bears the following two (2) consecutive courses West a distance of.257.65 feet; and (1) South 02*51'17 East a distance of 211.00 feet; (2) South 85*10*50 thence from the said POINT OF BEGINNING run South 02*5',117- Ex3t, along the Easterly boundary line of the saIdL hereinabove described parcel. a distance of 50.03 feet; thence I eaving said Easterly line run Westerly, along a line measured 50.00 feet Southerly of, at right bugles ftoka and parellel with the Northerly, boundary line of the said parcel, a distance of 13.40 feet; thence South 88*58'47- West, 201.59 feet to a point lying In the Westerly boundary line of the said. hereinabove described 1.25 acre parcel; C thence Ncrth 02*51117" East, along the said Westerly line. 50.11 feet C C to Northwesterly corner of the said parcel; thence Easterly along the Northerly boundary line of the said parcel the following three (3) consecutive courses: (1) North 88*5847" East, 53-82 feet; thence (2) NU&04 02"'9,06" Vest, 15.09 fcet; _--d 0"ence (3) Easterly 85*10'50- East, 162.46 feet to the POINT OF BEGINNING. END OF DOCUM7W END OF'DOC UMEN� F371 map may or maynot be a survey of the land,depictW on. You should not rel1y upon it for any purpose other orientation to the general locailon ofthe' parcel or els depicted. Mid Valley Title'and EscroW Company ressly disclaims any liability frx alleged toss of Sgq that may. wult from reliance -upon this mao. PTN. SEC. 2, T.19N. R,7E. M.D.B.&M. 6 .22Ac 73-41 F37] E Butte Count Assessor's Map Book �3,' Page 41 CREAM aY 081 CREATO ON 6-4-2WI NOM Auc ' Damah = f" usewment pwp� RNSED BY 09 1 REVISED ON 6-4-2001 mly ad my wi co.Utute kqW pffcd� OWCTNE 2001-02 ROU PmWous Book 37, Patian Of Po" 45 CompRod W Me Butte Camly Anv�'v Offke 11 99-0469 E 59 Kirkwood Way, Clipper Mills (retag elec ser)MH OFFICE COPY rAddress ----------------- GAS Meter By Date- ELECTRI Meter By N D -7 COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive -_ Oroville, California 95965 * Telephone (530) 538-7541 PE MIT -NO. (Rev. 12/96) APPLICATIO14AND PERMIT I ASSESSOR PARCEL NUMBER 07 -3 -79 -n -M7 ZONING' I BUILDING PERMIT OWNER M_ DESAINO TELEPHONE A7 SO. FT. OCC. BUILDING VALUATION OWNEWS MAILING ADDRESS P Q ROT 63., CLIPPER MILLS CA 05030 _T CONTRACTOR'S NAME (N -NPR ELEPH)NE CONTRACTOWS MAILING ADDRESS CONSTRUCTION LENDER Fireplace UENDER'S MAILING ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Fee $ 20.00 —Filina Permit Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Plan Checking Fee $ BUILDINSV P, RZIRMOD WAY, CLIPRR MI= Energy Plan Checking Fee $ PERMIT FEE $ LOT NO. SUBDIVISIONS NAME PARCErP PLUMBING PERMIT Filing Fee 20.00 Each Trap T.00 USEOFSTRUCTURE SF 0 Duplex 0 MobilehomeXO Other _7� SPECIFY Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 15.00 TYPE OF WORK New [I Addition 0 Remodel 0 Utilities 0 Installation 0 Other b' , Describe Work: RETAG HIM SER Gas piping sy2tem I - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W F @20.00 PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 d 500V OR LE:: Main Service OA OR U. 23.0013.00 f f LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisionsiof Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: 1, asownerof theproperty, ormy employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. 0 1 am exempt under Sec. Business and Professions Code for this reason WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: A�� I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I iav, and will maintain workers' compensation Insurance, as required by Section G h 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed if the permit is for4�rk of a valuation of one hundred dollars ($100) or less.) I 0 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor 06de, I shall forthwith com I ply , with those provisl;ns. X) 11. Date 3 q _19nature of Aopl&�ri- O'Cigirier 0 Contractor 0 Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING UP. OCC. so OR ADDNS. ACC.-BLDS 3.50FT. _& NEW CONST. -OUTLET NON_RESID =11, CIRCUITS 97.50 OWER APPARATU PSINGUE OUTLET C SIR. OUTLET OR FIXTURES 20 1.00 Ex. Occup. BAL .50 O.FIXEO A R, 5.00 Occup. PCPRM.)OE —Ex. Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PRE INSP �3.00 PERMIT FEE $ 66.00 MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEt $ Mobile Home Installation Fee $ Energy Inspection Fee $ Occ CONST. TYPE TOTALFEE$ HAZ- I D. FEES IMP I FLOOD I CDF PARCEL PD] HD ISSUE' This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. By Date PERMIT EXPIRES ON I I (Date) ReceiptNo. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDEN ROD -APPLICANT OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your siguApm, 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. I personally plan to provide the major labor and materials for construction of the proposed, property improvement: YES 9!�, NO 13 2 I HAVE Ok HAVE NOT 13 signed an application for a building permit for the proposed wp; I have contracted with the following person (firm) to provide the proposed construction:.f' NAi�E ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. 4. I plan to provide portions of this work, but I have hired the following person to coordiuiate; .. supervise; and provide the major work: NAME: ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. S. 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: PROPERTYOiVNER: 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 wd returned to our office before we are permitted to issue the permit. OVER COUNTY OF BUTTE - Department of Public Works 7 County Center Drive, Oroville, CA 95965 Phone: 9161534-4541 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) 5 2. I (have/have not) ve signed an application for a building permit for the proposed work. 3. 1. have contracted with the following person (firm) to provide the proposed onstruction: . 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 Number - 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. 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)S _. 2. I (have/have not) ( e 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. 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 40 --- Social Security Number _ 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.