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Building Permit Application - Contractor

  1. Building Permit Application - Contractor
    This building permit application is for licensed CONTRACTORS ONLY. Insufficient or left out information will result in your application being rejected.
  2. Permit Type*
  3. Property Owner's Contact Information
  4. Applicant's Contact Information
  5. Is the Applicant an Agent for the Contractor?*
  6. Contractor's Information
  7. Additional Contacts
  8. Select Title:
  9. Building Project Identification
  10. Licensed Contractor's 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
  11. Identify Workers' Compensation Coverage
    Worker's Compensation Declaration 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's fees.

    I hereby affirm under penalty of perjury ONE of the following declarations:
  12. Declaration: Certificate of Consent to Self-Insure
    I have and will maintain a certificate of consent to self-insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
  13. Declaration: Workers' Compensation Insurance
    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
  14. Declaration: Compliance with Workers' Compensation Laws for Sole Ownership
    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.
  15. Identify Lending Agency
    Declaration Regarding Construction Lending Agency

    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 (Section 3097, Civil Code).
  16. Please upload all construction documents for your project, i.e. plot plans, floor plans, blueprints, energy documents, etc. Failure to provide all required documents will result in the application being rejected.
  17. Authorization
    By my signature below, I certify to each of the following:
    I am the property owner or authorized to act on the property owner's behalf.
    I have read this application and the information I have provided is correct.
    I agree to comply with all applicable city and county ordinances and state laws relating to building construction.
    I authorize representatives of this city or county to enter the above-identified property for inspection purposes.
  18. Leave This Blank:

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