What is the Permittee Authorization Form Contractor Declaration?

It collects a contractor’s license and workers’ compensation declarations, lending agency information when applicable, and the permit applicant’s certifications and inspection authorization.

Who completes this contractor declaration?

The form says the permit applicant certifies they are a licensed contractor or authorized to act on the contractor’s behalf. Contractor representatives must provide a separate authorization form.

How do I submit the contractor declaration?

The form lists the Building Department’s mailing address and planreview@victorvilleca.gov, but does not specify a submission method. Check the city website for current contact details.

Victorville, CA · San Bernardino County

No notary required

Permittee Authorization Form Contractor Declaration

This form records a contractor’s license, workers’ compensation and lending agency declarations, and the permit applicant’s certifications for work in Victorville.

What this form is

Contractors and permit applicants use this form to provide declarations and certifications for the work covered by a construction permit. It asks for the permit number and site address, contractor license details, workers’ compensation coverage information, any construction lending agency details, and the applicant’s name and date. The applicant also certifies the application information and authorizes City of Victorville Development Services representatives to enter the property for inspection.

Who needs it

A California licensed contractor or someone authorized to act on the contractor’s behalf completes the declarations for the construction permit applicant.

How to submit it

The form identifies the Building Department and lists 14343 Civic Drive, PO Box 5001, Victorville, CA 92393-5001, and [email protected]. It does not state how to submit the completed form.

About notarization

This document is signed without a notary; its declarations are made under penalty of perjury, and the signer provides their name and date.

How to submit this form

1
Download The Form
Download the Permittee Authorization Form Contractor Declaration PDF.
2
Complete The Declarations
Enter the permit and site details, contractor license information, workers’ compensation declarations, and any lending agency information.
3
Complete Applicant Certification
Provide the applicant’s name and date and complete the required certification and inspection authorization.
4
Submit To The City
Use the Building Department contact information shown on the form; check the city website for current submission instructions.

Frequently asked questions

What is the Permittee Authorization Form Contractor Declaration?: It collects a contractor’s license and workers’ compensation declarations, lending agency information when applicable, and the permit applicant’s certifications and inspection authorization.
Who completes this contractor declaration?: The form says the permit applicant certifies they are a licensed contractor or authorized to act on the contractor’s behalf. Contractor representatives must provide a separate authorization form.
Do I need a notary for the Permittee Authorization Form Contractor Declaration?: No. This document is signed without a notary. Its declarations are made under penalty of perjury, and the signer provides their name and date.
How do I submit the contractor declaration?: The form lists the Building Department’s mailing address and [email protected], but does not specify a submission method. Check the city website for current contact details.

Need something notarized?

This Permittee Authorization Form Contractor Declaration doesn’t need a notary — but if you have another Victorville form that does, a commissioned online notary can help.