Culver City, CA · Los Angeles County
Owner Statement and Acknowledgment of Compliance
Property owners and contractors complete this statement to certify required safety and water-saving features are installed for a permitted project.
What this form is
This form records an owner’s and contractor’s certification that applicable smoke and carbon monoxide detectors, water fixtures, and seismic gas shut-off valves have been installed. The city requires the completed statement for covered projects before final inspection. It asks for the permit number, project address, applicable project checkboxes, and owner and contractor information, signatures, and dates.
Who needs it
Property owners and contractors responsible for covered building permit work complete and sign this statement before the project’s final inspection.
How to submit it
Mail or email the completed, signed form to the Building Inspector of record before final inspection.
About notarization
This document is signed without a notary; the owner declares under penalty of perjury that the statement is true and correct.
How to submit this form
- 1
Download The Form
Download the Owner Statement and Acknowledgment of Compliance.
- 2
Complete The Project Details
Enter the permit number and address, and check the applicable boxes.
- 3
Get Required Signatures
Have the owner and contractor complete their information and sign and date the form.
- 4
Submit Before Final Inspection
Mail or email the completed form to the Building Inspector of record before final inspection.
Frequently asked questions
- Do I need a notary for the Owner Statement and Acknowledgment of Compliance?
- No. The document has no notary block; the owner signs and declares under penalty of perjury that the statement is true and correct.
- How do I submit the compliance statement?
- Mail or email the completed, signed form to the Building Inspector of record before final inspection.
- Who signs the statement?
- The property owner and contractor sign it. The form notes that a contractor is required unless the permit is O/B.
- What information does the form ask for?
- It asks for the permit number, project address, applicable project checkboxes, and owner and contractor details, signatures, and dates.