CALBO Jan 1, 2009 Permit Application Template – modified for City of Moorpark Issue# 1 Rev 6 Issue Date: 10/08/2020
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C
ITY OF
M
OORPARK
BUILDING AND SAFETY PERMIT APPLICATION
A. Project Information
Property Location or Address:
B. Applicant Information (Individual at the public counter submitting application)
Applicant Name: Business Name:
Street Address:
City: Zip: Telephone:
C. Design Professional Information (Preparer of the plans)
Professsionals Name: Business Name:
Street Address:
City: Zip: Phone:
License No.: Expiration Date:
D. Owner’s Information (Property Owner)
Property Owner’s Name: Business Name:
Street Address:
City: Zip: Phone:
DESCRIPTION OF WORK:
Valuation:
(Valuation is the total cost of labor & materials)
If the Owner is acting as Owner Builder please attach Owner/Builders Package form and complete the following declaration otherwise
skip to section E
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 country 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, 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 contacting with licensed Contractors to construct the project
(Section 7044, Business and Professions Code: The
Contractors’ State Licnse 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 Name:
Property Owner or Authorized Agent signature: _______________________________________ Date:
BUILDING AND SAFETY DIVISION | 799 Moorpark Avenue, Moorpark, California 93021
Phone Number (805) 517-6272 | www.moorparkca.gov
