Owner Builder Form – Fill Out and Use This PDF

PROJECT NO.: ____________________________

APPROVAL NO.: ____________________________

Dear Property Owner:

An application for a building permit has been submitted in your name listing yourself as the builder of the prop-

erty improvements specified at: ____________________________________________________________.

We are providing you with an Owner-Builder Acknowledgement and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder (per California Health and Safety Code Section 19825). We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us in person or at the address listed above.

OWNER’S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION

DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.

____1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an “Owner-

Builder” building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner’s insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property.

____2. I understand building permits are not required to be signed by property owners unless they are respon-

sible for the construction and are not hiring a licensed Contractor to assume this responsibility.

____3. I understand as an “Owner-Builder” I am the responsible party of record on the permit. I understand that

I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own.

____4. I understand Contractors are required by law to be licensed and bonded in California and to list their

license numbers on permits and contracts.

____5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and

the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an “employer” under state and federal law.

____6. I understand if I am considered an “employer” under state and federal law, I must register with the state

and federal government, withhold payroll taxes, provide workers’ compensation disability insurance, and contribute to unemployment compensation for each “employee.” I also understand my failure to abide by these laws may subject me to serious financial risk.

Printed on recycled paper. Visit our web site at www.sandiego.gov/development-services. Upon request, this information is available in alternative formats for persons with disabilities.

DS-3042 (03-10)

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city of San Diego • Development Services Department • Owner - Builder Veriication

PROJECT NO.: ____________________________

APPROVAL NO.: ____________________________

____7. I understand under California Contractors’ State License Law, an Owner-Builder who builds single-family

residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calen- dar year, or all of the work is performed under contract with a licensed general building Contractor.

____8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable

for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials.

____9. I understand I may obtain more information regarding my obligations as an “employer” from the Internal

Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the Califor- nia Contractors’ State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more infor- mation about licensed contractors.

____10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand

that I am the party legally and financially responsible for proposed construction activity at the following address: _________________________________________________________________________________________

____11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will

abide by all applicable laws and requirements that govern Owner-Builders as well as employers.

____12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the

information I have provided on this form.

Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors’ State License Board may be unable to assist you with any finan- cial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verify- ing whether or not those Contractors are properly licensed and the status of their workers’ compensation insurance coverage.

Before a building permit can be issued, this form must be completed and signed by the property owner, and returned to the Development Services Department at the time of per- mit issuance. Note: If the property owner will not be present at permit issuance to provide proof of identity, the property owner’s signature must be notarized.

Property Owner Name (print): __________________________________________

Date: _____________________

Property Owner’s Signature: ___________________________________________

Date: _____________________