Laureldale, PA · Berks County
Homeowner’s Worker’s Compensation
Laureldale homeowners seeking a building permit use this affidavit to state they will not hire anyone else for the project.
What this form is
The affidavit states that the homeowner will not employ or hire other people for the project covered by a building permit. If the homeowner later hires anyone, the form says they must notify the Borough Office and provide proof of workers’ compensation coverage within three working days. It includes signature lines for the applicant and a borough employee, plus the property address.
Who needs it
A homeowner seeking a building permit for a project and stating they will not employ or hire other people needs this affidavit.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; no notarized attachment or related step is stated, and the applicant signs and dates the form.
How to submit this form
- 1
Download The Form
Download the Homeowner’s Worker’s Compensation form for your building permit project.
- 2
Complete The Affidavit
Complete the statement and provide the property address where the work will be done.
- 3
Sign The Form
Sign and date the applicant signature line.
- 4
Submit To The Borough
Submit the form to the city department named on it; check the city website for current contact details.
Frequently asked questions
- What is the Homeowner’s Worker’s Compensation form for?
- It records a homeowner’s statement that they will not employ or hire other people for the project for which they are seeking a building permit.
- Who needs to complete this form?
- A homeowner seeking a building permit for a project and stating they will not hire anyone else for the work uses this affidavit.
- Do I need a notary for the Homeowner’s Worker’s Compensation form?
- No. The document has signature lines for the applicant and a borough employee but no notary block or notarized attachment; the applicant signs and dates it.
- How do I submit the Homeowner’s Worker’s Compensation form?
- Submit it to the city department named on the form; check the city website for current contact details. The document lists the Borough Office for later notification if you hire other people.
Need something notarized?
This Homeowner’s Worker’s Compensation doesn’t need a notary — but if you have another Laureldale form that does, a commissioned online notary can help.