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BUTTE COUNTY'SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM
(One Form per Building)
A. P. Number Building Building Department No.
School District Ck1co City .= County Jurisdiction
Property Owner L,.,,/1"N O &,A &b
Project Location/Address EACNUU�- _ � � OCest�--
Subdivision Lot Number
Residential Development:
Sq. Footage
#.of Living MHI Addition (Group R)
Units
Commercial/Industrial:
OSq. Footage
New Addition (Including Exterior
Roofed Areas)
ng Department Representative
�z.zv- C,
Date
,.>>."`; (Floor Plans reviewed by School District Personnel)
:r
District Id No. z1 7
(� (A-" School District certifies that
n.
(Apbllidarif Wame) (Phone Number)
reet •Aaaress
t•
9�
t city (State) ) ' t/zip c ooae )
ha.s complied with the requirements of Resolution No. glQG6- 9/
by the payment of $ rO�, y7 representing /3&/squar feet.
t School District Representative ate
-
BANK NO_�Q
PAID BY CASH
REMARKS:
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white -applicant, yellow -building department, pink -school district
SCHOOL.FEE (8/8.8)
COUNTY OF BUTTE - De,partm£nt 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) 641=e�� .
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-pr-ov-ide--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.