Who completes the Owner-Builder Acknowledgement Form?

The property owner listed as the builder on a building permit application completes the form. An agent cannot sign it unless the property owner first obtains approval from the permitting authority.

How do I submit the Owner-Builder Acknowledgement Form?

Return the completed form to the agency responsible for issuing the permit. The form names the Building & Safety Division at 5050 Clark Ave., Lakewood, CA 90712.

When must I return the form?

The completed form must be read, initialed, signed, and returned before the city will issue a building permit in the property owner’s name.

Lakewood, CA · Los Angeles County

No notary required

Owner-Builder Acknowledgement and Information Verification Form

Lakewood property owners complete this form to acknowledge their responsibilities and verify information before the city issues an owner-builder building permit.

What this form is

Lakewood requires the property owner to read, initial, sign, and return this form before a building permit can be issued in the owner’s name. It asks for the property address or parcel number, the owner’s initials confirming understanding of twelve statements, a residence confirmation, and the owner’s signature and date.

Who needs it

Property owners listed as the builder on a Lakewood building permit application must complete and return this form before the permit is issued.

How to submit it

Return the completed form to the agency responsible for issuing the permit; the form identifies the Building & Safety Division at 5050 Clark Ave., Lakewood, CA 90712.

About notarization

The form is signed without a notary; when the permit is issued, the owner must present a driver’s license copy, form notarization, or other verification acceptable to the agency.

How to submit this form

1
Download The Form
Download the Owner-Builder Acknowledgement and Information Verification Form.
2
Complete The Form
Enter the property address or parcel number, read and initial each statement, answer the residence question, and sign and date the form.
3
Gather 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 The Form
Return the completed form to the agency responsible for issuing the permit; the form identifies the Building & Safety Division in Lakewood.

Frequently asked questions

Do I need a notary for the Owner-Builder Acknowledgement Form?: No. The form is signed without a notary, but when the permit is issued, the owner must present a driver’s license copy, form notarization, or other verification acceptable to the agency.
Who completes the Owner-Builder Acknowledgement Form?: The property owner listed as the builder on a building permit application completes the form. An agent cannot sign it unless the property owner first obtains approval from the permitting authority.
How do I submit the Owner-Builder Acknowledgement Form?: Return the completed form to the agency responsible for issuing the permit. The form names the Building & Safety Division at 5050 Clark Ave., Lakewood, CA 90712.
When must I return the form?: The completed form must be read, initialed, signed, and returned before the city will issue a building permit in the property owner’s name.

Need something notarized?

This Owner-Builder Acknowledgement and Information Verification Form doesn’t need a notary — but if you have another Lakewood form that does, a commissioned online notary can help.