Loomis, CA · Placer County
Owner-Builder Acknowledgment and Information Verification Form
Property owners applying for a building permit as owner-builders complete this form to acknowledge their responsibilities and verify information about the proposed construction.
What this form is
The form records the property owner’s understanding of owner-builder responsibilities and identifies the proposed construction address. The city requires the completed, signed form before issuing a building permit. It also includes an optional agent authorization section for an owner who designates someone to apply for, sign, and file permit documents on their behalf.
Who needs it
A property owner seeking a building permit as an owner-builder must complete the acknowledgment; owners designating an agent can also complete the authorization section.
How to submit it
Return the completed form to the agency responsible for issuing the permit before the building permit can be issued; the form provides no mailing details.
About notarization
This form has no notary block; the owner signs and dates under penalty of perjury, and presents identification, notarization, or other accepted signature verification when the permit is issued.
How to submit this form
- 1
Download The Form
Download the Owner-Builder Acknowledgment and Information Verification Form.
- 2
Read And Complete It
Read and initial each acknowledgment, provide the requested property and owner information, and sign and date the form.
- 3
Complete Agent Authorization If Needed
If designating an agent, complete the authorization section with the project, agent, and property owner information.
- 4
Return The Form
Return the completed form to the agency responsible for issuing the permit before the building permit can be issued.
Frequently asked questions
- Do I need a notary for the Owner-Builder Acknowledgment Form?
- No notary block appears on the form. The owner signs and dates under penalty of perjury; when the permit is issued, the form calls for identification, notarization, or other verification acceptable to the agency.
- Who completes the Owner-Builder Acknowledgment Form?
- The property owner named as the owner-builder on a building permit application completes and signs the acknowledgment. An agent cannot execute the notice unless the permitting authority first approves.
- How do I submit the Owner-Builder Acknowledgment Form?
- Return the completed and signed form to the agency responsible for issuing the permit before the building permit can be issued. The form does not give mailing or contact details.
- Can I authorize someone to apply for my owner-builder permit?
- Yes. The form includes an agent authorization section for the owner to identify an agent and authorize them to apply for, sign, and file documents. The notice itself remains the owner’s personal responsibility.