Homeowner Workers’ Compensation Exemption Affidavit

This affidavit is for owners of qualifying owner-occupied homes who apply for a building permit and need to document an exemption from workers’ compensation coverage.

What this form is

The BP-1 affidavit lets the owner of a one- to four-family, owner-occupied residence state why specific proof of workers’ compensation coverage is not required for the building permit. It asks the homeowner to select an applicable exemption, certify the information, and provide a signature, date, telephone number, printed name, and property address. The document describes limits on using the exemption when paid work reaches 40 hours per week.

Who needs it

A homeowner listed as the general contractor on a building permit for a one- to four-family, owner-occupied residence may file this affidavit if an exemption applies.

How to submit it

Submit it to the city department named on the form; check the city website for current contact details.

About notarization

The document has homeowner signature and date lines but no notary block; its text says that once notarized, the BP-1 serves as an exemption for workers’ compensation and disability benefits coverage.

How to submit this form

1
Download The BP-1
Download the Homeowner Workers’ Compensation Exemption Affidavit PDF.
2
Complete The Affidavit
Select the applicable exemption and provide the requested homeowner, property, signature, and date information.
3
Check Your Work Situation
Review the form’s conditions, including its provisions for homeowners hiring or paying individuals for fewer than 40 hours per week.
4
Submit To The City
Submit the completed affidavit to the city department named on the form; check the city website for current contact details.

Frequently asked questions

Do I need a notary for the Homeowner Workers’ Compensation Exemption Affidavit?: No notary block is included on this document. Its text says that once notarized, the BP-1 serves as an exemption for workers’ compensation and disability benefits coverage.
Who can use the BP-1 affidavit?: It is for homeowners listed as the general contractor on a building permit for a one- to four-family, owner-occupied residence, including condominiums, when an exemption applies.
How do I submit the BP-1 affidavit?: Submit it to the city department named on the form; check the city website for current contact details.

Need something notarized?

This Homeowner Workers’ Compensation Exemption Affidavit doesn’t need a notary — but if you have another Watertown form that does, a commissioned online notary can help.