South Pasadena, CA · Los Angeles County
Owner-Builder Declaration, Workers Compensation Declaration and Authorization of Entry
Property owners complete and sign this form before the city can issue an owner-builder permit for construction at their project address.
What this form is
The form records an owner's acknowledgment of owner-builder responsibilities, authorization for city representatives to enter the property for inspections, and a workers' compensation declaration. The city requires it to be completed and signed before issuing an owner-builder permit. It asks for the project address, the owner's declarations, and, where applicable, workers' compensation insurance details.
Who needs it
A property owner applying for an owner-builder permit must complete and sign this form before the permit can be issued.
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 form is signed without a notary; its workers' compensation declaration is affirmed under penalty of perjury, and the signer signs and dates it.
How to submit this form
- 1
Download The Form
Download the Owner-Builder Declaration, Workers Compensation Declaration and Authorization of Entry PDF.
- 2
Complete The Form
Enter the project address and complete the owner-builder and workers' compensation declarations.
- 3
Sign And Date
Sign and date the form to provide the declarations and authorize city representatives to enter for inspections.
- 4
Submit To The City
Submit the completed form to the city department named on it; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the Owner-Builder Declaration?
- No. The form is signed without a notary. The workers' compensation declaration is affirmed under penalty of perjury, and the signer signs and dates the form.
- Who must complete this form?
- The property owner must complete and sign it before the city can issue an owner-builder permit.
- What information does the form request?
- It requests the project address, the owner's declarations and authorization for city inspections, and workers' compensation insurance details where applicable.
- How do I submit the form?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Owner-Builder 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.