HomeMy WebLinkAboutDBP-44_Owner_Builders_Info_Reqd_on_Application_&_Building_PermitButte County Department of Development Services
PERMIT CENTER
7 County Center Drive, Oroville, CA 95965
Main Phone 530.538.7601 Fax 530.538.7785
www.buttecounty.net/dds
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FORM NO
DBP-44
OWNER BUILDER & CONTRACTOR IMPORTANT
INFORMATION THAT IS REQUIRED ON THE
APPLICATION AND BUILDING PERMIT
The following information will need to be provided on the building permit application form
(DBP-03) and/or on the issued building permit (which is printed in our office). An owner builder
verification form (DBP-43) may also be required. NOTE: Please do not submit this form as your
building permit application or owner builder verification. This handout is provided as a guide to
the information you will be asked to provide for permitting purposes.
#1 YOU WILL BE REQUIRED TO IDENTIFY YOUR BUILDING PROJECT
LOCATION (ADDRESS AND/OR ASSESSOR’S PARCEL NUMBER)
Property Location or Address:
This permit is to be issued in the name of the (_) Licensed Contractor or (_) the Property Owner
as the permit holder of record who will be responsible and liable for the construction.
Property Owner Information: Name Tel No
Mailing Address
Licensed Design Professional (Architect or engineer in charge of the project) Information:
Name License No.
Tel No Mailing Address
Description and valuation of work to be performed:
#2 IDENTIFY WHO WILL PERFORM THE WORK (Complete either 2a or 2b)
2a – CALIFORNIA LICENSED CONTRACTOR’S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my
license is in full force and effect.
Contractor Name and Address:
License Class and No(s). Contractor Signature
2b – OWNER-BUILDER’S DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors’ State License
Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable
item(s) (Section 7031.5, Business and Professions Code: Any city or county that requires a permit
to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires
the applicant for the permit to file a signed statement that he or she is licensed pursuant to the
provisions of the Contractors’ State License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he or she is exempt from licensure and
the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
(_) I, as owner of the property, or my employees with wages as their sole compensation, will do
(_) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section
7044, Business and Professions Code: The Contractors’ State License Law does not apply to an
owner of property who, through employees’ or personal effort, builds or improves the property,
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provided that the improvements are not intended or offered for sale. If, however, the building or
improvement is sold within one year of completion, the Owner-Builder will have the burden of
proving that it was not built or improved for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed Contractors to construct
the project (Section 7044, Business and Professions Code: The Contractors’ State License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for the
projects with a licensed Contractor pursuant to the Contractors’ State License Law.).
(_) I am exempt from licensure under the Contractors’ State License Law for the following
reason:
By my signature below I acknowledge that, except for my personal residence in which I must
have resided for at least one year prior to completion of the improvements covered by this permit,
I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed
in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044
of the Business and Professions Code, is available upon request when this application is
submitted or at the following Web site: http://www.leginfo.ca.gov/calaw.html.
Property Owner or Authorized Agent signature Date
#3 IDENTIFY WORKERS’ COMPENSTATION COVERAGE AND LENDING AGENCY
WARNING: FAILURE TO SECURE WORKERS’ COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN
ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY’S FEES.
WORKERS’ COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
(_) I have and will maintain a certificate of consent to self-insure for workers’ compensation,
issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code,
for the performance of the work for which this permit is issued. Policy No.
(_) I have and will maintain workers’ compensation insurance, as required by Section 3700 of the
Labor Code, for the performance of the work for which this permit is issued. My workers’
compensation insurance carrier and policy number are:
Carrier Policy No
Expiration Date Name of Agent Tel No ________________
(_) I certify that, in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the workers’ compensation
laws of California, and agree that, if I should become subject to the workers’ compensation
provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the
performance of the work for which this permit is issued (Section 3097, Civil Code).
Lender’s Name and
Address _______________________________________________________________________
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#4 DECLARATION BY CONSTRUCTION PERMIT APPLICANT
By my signature below, I certify to each of the following:
I am (_) a California licensed contractor or (_) the property owner* or (_) authorized to act
on the property owner’s behalf**.
I have read this construction permit application and the information I have provided is correct.
I agree to comply with all applicable city and county ordinances and state laws relating to
building construction.
I authorize representatives of this city or county to enter the above-identified property for
inspection purposes. *requires separate verification form California Licensed Contractor,
Property Owner* or Authorized Agent**: **requires separate authorization form
Signature _________________________________
Date __________________________