B25-0845 - 25632 PURPLE SAGE LNFINALED
10/28/25
REV 08/29/24
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PROPERTY OWNER'S PACKAGE
DEVELOPMENT SERVICES
Building and Safety
[Disclosures and Forms for Owner-Builders Applying for Construction Permits]
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at .
We are providing you with an Owner-Builder Acknowledgment and Verification of Information 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. We will not
issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this
form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property
owner, obtain the prior approval of the permitting authority.
OWNER-BUILDER ACKOWLEDGMENT AND VERIFICATION OF INFORMATION
Please 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 responsible 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.
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 calendar
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.
REV 08/29/24
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PROPERTY OWNER'S PACKAGE
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 California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
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 financial 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 verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage. Further, you are advised that each contractor or subcontractor must
have a current and valid City of San Juan Capistrano business license in order to perform work in the City
and in which we may ask you to verify.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned
to the agency responsible for issuing the permit.
NOTE: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the
agency is required to be presented when the permit is issued to verify the property owner's signature.
PROPERTY OWNER SIGNATURE DATE
NOTE: The following Authorization is required to be completed by the property owner only when designating an agent of the
property owner to apply for a construction permit for the Owner-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder
Permit for my project:
SCOPE OF CONSTRUCTION PROJECT OR DESCRIPTION OF WORK
PROJECT LOCATION OR ADDRESS
AUTHORIZED AGENT NAME PHONE
AUTHORIZED AGENT ADDRESS
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy.
NOTE: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is
required to be presented when the permit is issued to verify the property owner's signature.
PROPERTY OWNER SIGNATURE DATE