San Anselmo, CA · Marin County
Owner/Builder Declaration Form and Disclosures
Property owners applying for a building permit as owner-builders use this form to identify the project, declare who will perform the work, and acknowledge their responsibilities.
What this form is
The form collects project, property owner, and design professional information, and asks the applicant to identify who will perform the work and declare workers’ compensation coverage and any construction lending agency. The Town says it will not issue a building permit until the owner has read, initialed, signed, and returned the acknowledgment and verification section. Owners can also authorize an agent to apply for and file permit documents.
Who needs it
Property owners applying for a building permit as owner-builders need this form; owners who designate an agent also complete the agent authorization section.
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 has no notary block; the form says the agency may require notarization or other verification to verify the property owner’s signature when the permit is issued.
How to submit this form
- 1
Download The Form
Download the Owner/Builder Declaration Form and Disclosures.
- 2
Complete The Project Details
Enter the property, owner, design professional, and work information, then select the applicable work and coverage declarations.
- 3
Read And Sign The Disclosures
Read and initial the acknowledgment statements, sign and date the form, and complete the agent authorization section if applicable.
- 4
Submit The Form
Return the completed form to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What is the Owner/Builder Declaration Form for?
- It provides project and owner information, identifies who will perform the work, and records declarations and acknowledgments required for an owner-builder building permit.
- Who needs to complete this form?
- Property owners applying for a building permit as owner-builders complete it. Owners who authorize an agent to apply for permit documents also complete the authorization section.
- Do I need a notary for the Owner/Builder Declaration Form?
- No notary block is included. The form says the agency may require notarization or other verification to verify the owner’s signature when the permit is issued.
- How do I submit the Owner/Builder Declaration Form?
- Submit it to the city department named on the form; check the city website for current contact details.