South Pasadena, CA · Los Angeles County
Licensed Contractor’s Declaration, Workers’ Compensation Declaration and Authorization of Entry
Licensed contractors complete this form for a building permit, declaring their license and workers’ compensation status and authorizing city property inspections.
What this form is
This form collects a licensed contractor’s license type, number, and expiration date, along with a workers’ compensation declaration and authorization for a city representative to enter the property for permit inspections. The signer affirms the license is in force, agrees to follow applicable laws and ordinances, and selects a workers’ compensation declaration. The form also asks for project address and, where applicable, insurance or certificate details.
Who needs it
A licensed contractor applying for a building permit who must declare license and workers’ compensation information and authorize property inspections.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the workers’ compensation declaration is made under penalty of perjury, and the signer signs and dates the form.
How to submit this form
- 1
Download The Form
Download the Licensed Contractor’s Declaration, Workers’ Compensation Declaration and Authorization of Entry PDF.
- 2
Complete The Form
Enter the project address, contractor license details, and the applicable workers’ compensation declaration.
- 3
Provide Insurance Details
If applicable, enter the certificate number, insurance carrier, policy number, and policy expiration date.
- 4
Sign And Date
Print your name or use an e-signature, then provide the date.
- 5
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the Licensed Contractor’s Declaration?
- No. This document is signed without a notary. The workers’ compensation declaration is made under penalty of perjury, and the signer signs and dates the form.
- How do I submit the contractor declaration?
- The form does not provide submission instructions. Submit it to the city department named on the form; check the city website for current contact details.
- What information does the form ask for?
- It asks for the project address, contractor license type, number and expiration date, a workers’ compensation declaration, and applicable insurance or certificate details.
- What does the authorization of entry allow?
- The signer authorizes a representative of the city to enter the property for which the permit was applied for, for the purpose of making inspections.
Need something notarized?
This Licensed Contractor’s Declaration, Workers’ Compensation Declaration and Authorization of Entry doesn’t need a notary — but if you have another South Pasadena form that does, a commissioned online notary can help.