Dunsmuir, CA · Siskiyou County
Owner Builder Acknowledgement Form
Property owners applying for a construction permit as owner-builders complete this package to acknowledge their responsibilities and provide permit-related certifications.
What this form is
This package includes an owner-builder acknowledgment, an optional agent authorization when an agent applies, and a detector self-certification. The city says it must be completed and returned before an owner-builder building permit can be issued. It asks for owner and project details, acknowledgments and signatures; the detector certification records smoke and carbon monoxide detector information.
Who needs it
Property owners applying for a construction permit as owner-builders need the acknowledgment; owners designating an agent complete the authorization too.
How to submit it
Return the completed acknowledgment to the agency responsible for issuing the permit at 5915 Dunsmuir Avenue, Dunsmuir, CA 96025. The detector certification must be returned to the city building inspector before final sign-off of permits requiring compliance.
About notarization
This form has no notary block and is signed without a notary; it says notarization or other acceptable verification may be presented when the permit is issued.
How to submit this form
- 1
Download the Form
Download the owner-builder package for your construction permit.
- 2
Complete the Acknowledgment
Read and initial each statement, provide the requested project information, and sign and date the form.
- 3
Complete Related Forms
Complete the agent authorization only if designating an agent. Complete the detector certification when it applies to your permit.
- 4
Submit to the City
Return the acknowledgment to the permit-issuing agency at 5915 Dunsmuir Avenue, Dunsmuir, CA 96025.
Frequently asked questions
- What does the Owner Builder Acknowledgement Form cover?
- It records an owner's understanding of owner-builder responsibilities for a construction permit and includes an agent authorization and detector self-certification.
- Who completes the agent authorization?
- The property owner completes the authorization only when designating an agent to apply for a construction permit as an owner-builder.
- Do I need a notary for the Owner Builder Acknowledgement Form?
- No. The form has no notary block and is signed without a notary. It says notarization or other verification acceptable to the agency may be presented when the permit is issued.
- How do I submit the Owner Builder Acknowledgement Form?
- Return the completed acknowledgment to the agency responsible for issuing the permit at 5915 Dunsmuir Avenue, Dunsmuir, CA 96025. Return the detector certification to the building inspector before applicable final sign-off.
Need something notarized?
This Owner Builder Acknowledgement Form doesn’t need a notary — but if you have another Dunsmuir form that does, a commissioned online notary can help.