Amador County, CA · Amador County
Owner-Builder Form
Property owners applying for an encroachment permit as owner-builders complete this form to acknowledge their responsibilities and declare their exemption from contractor licensing.
At a glance
- Issued by
- City of Amador County · Amador County, Amador County, California
- Notarization
- Not required: file this form without a notary.
- Official source
- amadorcounty.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Amador County requires this form before issuing an encroachment permit to a property owner listed as the builder. The owner reads and initials responsibility statements, completes an owner-builder declaration and workers’ compensation declaration, and signs and dates the form. If an agent acts for the owner, the form notes that an Authorization of Agent Form is required.
Who needs it
Property owners applying for an encroachment permit in their own name as the builder must complete this form before the county issues the permit.
How to submit it
Return the completed form to the Transportation and Public Works Department, 810 Court Street, Jackson, CA 95642-2132, or contact [email protected]. When the permit is issued, present a copy of the owner’s driver’s license, form notarization, or other verification acceptable to the agency.
About notarization
This form has no notary block and the signer signs and dates it; the county may accept form notarization as one option to verify the property owner’s signature when issuing the permit.
How to submit this form
- 1
Download the Form
Download the Owner-Builder Form for an encroachment permit.
- 2
Complete the Required Sections
Read and initial the owner acknowledgments, complete the owner-builder declaration and workers’ compensation declaration, then sign and date.
- 3
Gather Required Verification
If an agent is involved, include the required Authorization of Agent Form. The owner’s signature must be verified when the permit is issued.
- 4
Submit to the County
Return the form to the Transportation and Public Works Department at the address shown on the form.
Frequently asked questions
- Who completes the Owner-Builder Form?
- The property owner completes it when applying for an encroachment permit in their own name as the builder. An agent cannot sign unless the permitting authority gives prior approval.
- Do I need a notary for the Owner-Builder Form?
- No notary block is provided; the signer signs and dates the form. When issuing the permit, the county may accept form notarization or other acceptable verification of the owner’s signature.
- How do I submit the Owner-Builder Form?
- Return it to the Transportation and Public Works Department at 810 Court Street, Jackson, CA 95642-2132. The form also lists [email protected].
- What else may be needed if an agent signs?
- The form says an Authorization of Agent Form is required and that an agent cannot execute the notice without prior approval from the permitting authority.