Piedmont, CA · Alameda County
Owner-Builder Acknowledgement and Verification Information
Property owners applying for a building permit as owner-builders use this form to acknowledge their responsibilities and provide project and insurance information.
What this form is
Piedmont requires the property owner to complete and return this form before it will issue an owner-builder building permit. It asks for project and owner details, initials acknowledging owner-builder responsibilities, a licensing exemption selection, workers’ compensation information, and signatures. It also includes an agent authorization section for owners who want someone else to act on their behalf.
Who needs it
A property owner applying for a Piedmont building permit as an owner-builder must complete and return this form.
How to submit it
Complete and sign the form, then return it to the agency responsible for issuing the permit at 120 Vista Ave., Piedmont, CA 94611. The document says owner signature verification is required when the permit is issued.
About notarization
This form is signed without a notary; it includes declarations under penalty of perjury and allows form notarization as one signature-verification option when the permit is issued.
How to submit this form
- 1
Download The Form
Download the Owner-Builder Acknowledgement and Verification Information form.
- 2
Complete The Form
Enter the project and owner information, initial each acknowledgement, complete applicable declarations, and sign and date the form.
- 3
Prepare Signature Verification
When the permit is issued, present a copy of the owner’s driver’s license, form notarization, or other verification acceptable to the agency.
- 4
Return It To The City
Return the completed form to the permit-issuing agency at 120 Vista Ave., Piedmont, CA 94611.
Frequently asked questions
- Do I need a notary for the Owner-Builder Acknowledgement and Verification Information?
- No. The form is signed without a notary, but it allows form notarization as one option for verifying the owner’s signature when the permit is issued.
- How do I submit the owner-builder form?
- Return the completed and signed form to the agency responsible for issuing the permit at 120 Vista Ave., Piedmont, CA 94611.
- What information does the form ask for?
- It asks for owner and project details, acknowledgements of owner-builder responsibilities, a licensing exemption selection, workers’ compensation information, and signatures.
Need something notarized?
This Owner-Builder Acknowledgement and Verification Information doesn’t need a notary — but if you have another Piedmont form that does, a commissioned online notary can help.