Tiburon, CA · Marin County
Permittee Declaration
Licensed contractors and property owners complete this declaration for work covered by a Town of Tiburon building permit.
What this form is
This form records whether the permittee is a licensed contractor or an owner-builder and includes declarations about workers’ compensation and construction lending. The licensed contractor completes Sections A and C; the owner-builder completes Sections B and C, plus Section D when using a construction lending agency. It asks for project and permit details, declarations, and signatures.
Who needs it
A licensed contractor or property owner acting as an owner-builder completes the applicable sections for work covered by a Town of Tiburon permit.
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; its declarations are made under penalty of perjury, and the signer signs and dates the applicable sections.
How to submit this form
- 1
Download The Form
Download the Permittee Declaration PDF for your Town of Tiburon project.
- 2
Complete Applicable Sections
Enter the project address and permit number, then complete the sections for a licensed contractor or owner-builder.
- 3
Gather Relevant Details
Provide applicable workers’ compensation information and construction lender details if using a construction lending agency.
- 4
Sign And Submit
Sign and date the applicable sections, then submit the form to the city department named on it.
Frequently asked questions
- Who completes the Permittee Declaration?
- A licensed contractor completes Sections A and C. An owner-builder completes Sections B and C, and completes Section D if using a construction lending agency.
- What information does the form request?
- It asks for the project address and permit number, applicable contractor or owner-builder declarations, workers’ compensation details, signatures, and lender information when applicable.
- Do I need a notary for the Permittee Declaration?
- No. The form has no notary block. Its declarations are made under penalty of perjury, and the signer signs and dates the applicable sections.
- How do I submit the Permittee Declaration?
- The form does not state a submission method or destination. Submit it to the city department named on the form; check the city website for current contact details.