Berkeley, CA · Alameda County
Permit Declarations
This form collects contractor, workers’ compensation, and ordinance declarations for contractors, property owners, or agents seeking an engineering utility permit.
What this form is
Use this form with an engineering public right-of-way utility permit request. It records project and contractor information, workers’ compensation coverage or exemption, and declarations about applicable city ordinances and air quality requirements. The signer affirms the declarations under penalty of perjury and agrees to comply with the stated requirements.
Who needs it
Contractors, property owners, or authorized agents seeking an engineering public right-of-way utility permit complete and sign the applicable declarations.
How to submit it
Submit permit applications online through the City of Berkeley Online Portal at https://permits.cityofberkeley.info/citizenaccess/Default.aspx.
About notarization
This document is signed without a notary; its contractor and workers’ compensation declarations are affirmed under penalty of perjury.
How to submit this form
- 1
Download The Form
Download the Permit Declarations PDF.
- 2
Complete The Declarations
Enter the permit and project information, complete the applicable contractor and workers’ compensation declarations, and review the ordinance statements.
- 3
Sign And Date
The contractor, owner, or authorized agent signs and dates the form and checks the applicable signer role.
- 4
Submit Online
Submit the permit application through the City of Berkeley Online Portal, as directed on the form.
Frequently asked questions
- What is the Permit Declarations form for?
- It collects project and contractor details, workers’ compensation declarations, and statements about applicable city ordinances and air quality requirements for an engineering utility permit.
- Who completes the Permit Declarations form?
- A contractor, property owner, or authorized agent seeking an engineering public right-of-way utility permit completes and signs the applicable declarations.
- Do I need a notary for the Permit Declarations form?
- No. This document is signed without a notary. Its contractor and workers’ compensation declarations are affirmed under penalty of perjury.
- How do I submit the Permit Declarations form?
- The document says permit applications should be submitted online through the City of Berkeley Online Portal at https://permits.cityofberkeley.info/citizenaccess/Default.aspx.
Need something notarized?
This Permit Declarations doesn’t need a notary — but if you have another Berkeley form that does, a commissioned online notary can help.