Patterson, CA · Stanislaus County
Owner-Builder Acknowledgment and Information Verification Form
Property owners complete this form to acknowledge Owner-Builder responsibilities and verify information before a building permit is issued in their name.
What this form is
The form explains Owner-Builder responsibilities and risks, then asks the property owner to read and initial statements, provide the project address, and sign and date. The city requires the completed form before issuing a building permit in the owner’s name. If the owner designates an agent, the form also includes an authorization section for the owner to complete.
Who needs it
Property owners listed as the builder on a building permit application must complete and return this form before the permit can be issued.
How to submit it
Sign and return the completed form to the agency responsible for issuing the permit at the official address indicated on the application. The document says the owner’s signature must be verified when the permit is issued.
About notarization
The form is signed without a notary; it says signature verification at permit issuance may include notarization or other agency-accepted verification, and an agent authorization includes a declaration under penalty of perjury.
How to submit this form
- 1
Download The Form
Download the Owner-Builder Acknowledgment and Information Verification Form.
- 2
Complete The Form
Read and initial each statement, provide the project address, and sign and date as the property owner.
- 3
Complete Agent Authorization If Needed
If designating an agent, complete the authorization section as the property owner.
- 4
Return The Form
Return the completed form to the permit-issuing agency at the official address indicated on the application.
Frequently asked questions
- Do I need a notary for the Owner-Builder Acknowledgment Form?
- No notary block is included. The form says signature verification at permit issuance may include notarization or another verification accepted by the agency; the agent authorization also includes a declaration under penalty of perjury.
- Who completes the Owner-Builder form?
- The property owner listed as the builder on the building permit application reads and initials the statements, supplies project information, and signs and dates the form.
- How do I submit the Owner-Builder form?
- Return the completed form to the agency responsible for issuing the permit at the official address indicated on the application.