Rio Dell, CA · Humboldt County
Owner-Builder Acknowledgment Form
Property owners applying for a construction permit as their own builder complete this form to acknowledge their responsibilities and verify project information.
What this form is
The form explains owner-builder responsibilities and risks, and the city says it must be completed before a building permit can be issued. The property owner reads and initials each statement, provides the project address and signs and dates the form. An agent authorization section is included for owners who designate someone to apply for, sign and file permit documents on their behalf.
Who needs it
Property owners applying for a construction permit as the owner-builder must complete and return this form before the permit is issued.
How to submit it
Return the completed form to the Community Development Department at 675 Wildwood Avenue, Rio Dell, CA 95562. The form says the owner’s signature must be verified when the permit is issued.
About notarization
This document is signed without a required notary; at permit issuance, the form allows notarization as one option for verifying the owner’s signature, alongside a driver’s license copy or other acceptable verification.
How to submit this form
- 1
Download The Form
Download the Owner-Builder Acknowledgment Form.
- 2
Complete The Acknowledgments
Read and initial each statement, provide the project information, and sign and date the form.
- 3
Complete Agent Authorization If Needed
Fill in the agent authorization section if you are designating someone to act on your behalf.
- 4
Return The Form
Return it to the Community Development Department at 675 Wildwood Avenue, Rio Dell, CA 95562.
Frequently asked questions
- What is the Owner-Builder Acknowledgment Form for?
- It records a property owner’s understanding of owner-builder responsibilities and verifies information for a construction permit application.
- Who completes this form?
- The property owner applying for the permit as the owner-builder completes the acknowledgments, project information and signature. An agent authorization section is included when an agent is designated.
- Do I need a notary for the Owner-Builder Acknowledgment Form?
- No. The form does not require a notary signature. At permit issuance, notarization is listed as one possible way to verify the owner’s signature, alongside a driver’s license copy or other acceptable verification.
- How do I submit the Owner-Builder Acknowledgment Form?
- Return the completed form to the Community Development Department at 675 Wildwood Avenue, Rio Dell, CA 95562.