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BUILDING PERMIT APPLICATION

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  12. APPLICANT INFORMATION
  13. Select one*
  31. *Jurisdictions may require written approval from the owner.
  35. Select one
  58. Select one*
  73. Licensed Contractors Declaration: I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
  77. Owner-Builder Declaration: I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
  79. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for the purpose of sale.)  I
  81. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professional Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law.).
  83. I am exempt
  90. Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations:
  92. 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.
  94. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are:
  99. (This section need not be completed if the permit is for one hundred dollars ($100) or less.)
  101. I 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 the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
  103. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest, and attorney fees.
  107. Construction Lending Agency Declaration:
  109. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
  114. I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY OR CITY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
  119. Please fill in all that apply
  124. Fire Sprinklers
  125. Hazardous Materials
  139. Description of Work (Please mark all that apply)
  141. Is this a Code Enforcement case?*
  145. Construction Type
  147. Construction Type (specific)
  153. Description of Building (Please mark all the apply)
  159. Existing:
  166. Additional Proposed:
  181. Setbacks
  192. Sewer
  194. Water Well
  198. Document Submittal
  207. PAYMENT METHOD Payment for plan review and permit fees may be paid with cash, check, or credit card. Only Visa, MasterCard, Discover Card can be accepted. Over-the-Phone credit card payments will not be accepted. The credit card and proper identification must be present with the applicant to be used unless a pre-arranged credit authorization form for fax permits only is on file.
  209. Leave This Blank:

  212. This field is not part of the form submission.