The LADBS Signature Declaration Form is the sworn attachment that goes with every building permit application filed with the Los Angeles Department of Building and Safety, and completing it correctly means filling in the permit and job address at the top, then signing only the declarations that match your role: Section 17b if a licensed contractor is doing the work, Section 17a if you are an owner-builder, plus Sections 18, 19, and 21 in every case. The form was last revised in September 2025.1City of Los Angeles – Department of Building and Safety. LADBS Signature Declaration Form Every declaration is signed under penalty of perjury, so what you check matters.
Where to Download the Current Form
The form is a free PDF on the LADBS website at dbs.lacity.gov, under plan check forms, and printed copies are available at any LADBS public counter.1City of Los Angeles – Department of Building and Safety. LADBS Signature Declaration Form Before you touch any of the declarations, fill in the permit application number and the job address at the top. Without those, the form has nothing to attach to.
Which Sections Apply to You
You do not complete every section. The form has five numbered declarations — 17a, 17b, 18, 19, and 21 — and the pair 17a/17b is either-or.
- A licensed contractor performing or supervising the work signs 17b, 18, 19, and 21.
- A property owner acting as their own builder signs 17a, 18, 19, and 21.
Signing both 17a and 17b, or signing the one that does not match your role, creates a conflict that plan check staff will send back.
Section 17b: Licensed Contractor’s Declaration
If a licensed contractor is doing the work, complete Section 17b. You are affirming that you hold an active license under Chapter 9 of Division 3 of the California Business and Professions Code (starting at Section 7000) and that the license is in full force. Enter your license class (for example, A, B, or a C with the specialty designation) and your license number.1City of Los Angeles – Department of Building and Safety. LADBS Signature Declaration Form There is no expiration date field; LADBS verifies status directly through the Contractors State License Board, so the class and number you write must match CSLB records. If you hold a B (general building) license, the form includes a reminder about the prime contract and subcontract limitations under Section 7057.
Section 17a: Owner-Builder Declaration
Property owners pulling their own permit sign Section 17a, claiming the exemption under Business and Professions Code Section 7044. Check one of two boxes:1City of Los Angeles – Department of Building and Safety. LADBS Signature Declaration Form
- You (or employees paid only in wages) will do the work, and the structure is not intended or offered for sale. If you sell it within a year of completion, the burden is on you to prove you did not build it for sale.
- You are contracting only with licensed contractors to build the project.
California Health and Safety Code Section 19825 requires anyone signing this declaration to show identification confirming they are the property owner, so bring a driver’s license or other government-issued ID.2California Legislative Information. California Health and Safety Code 19825 The same statute requires a separate Notice to Property Owner, which LADBS issues on its own letterhead. You must read, sign, and return that notice personally before the permit is issued.
Section 18: Workers’ Compensation Declaration
Every applicant completes this section, contractor or owner-builder, by checking one of three boxes:1City of Los Angeles – Department of Building and Safety. LADBS Signature Declaration Form
- Self-insured under a certificate issued by the Director of Industrial Relations under Labor Code Section 3700.
- Covered through a workers’ compensation carrier as required by Section 3700. Write in the carrier name and policy number.
- No employees in a way that triggers California’s workers’ compensation laws. If that changes during the job, you agree to obtain coverage immediately.
The form prints a bold warning that failing to secure coverage is unlawful and can result in criminal penalties and civil fines up to $100,000, plus the cost of compensation, damages under Labor Code Section 3706, interest, and attorney’s fees.2California Legislative Information. California Health and Safety Code 19825 Owner-builders who hire anyone other than licensed contractors, and whose total construction value reaches $500 or more in labor and materials combined, may be treated as an employer under state and federal law, which brings payroll tax withholding, disability insurance, and unemployment obligations along with it.
The “no employees” box is the correct choice for a solo owner-builder. Skipping Section 18 entirely, though, is one of the most common reasons a form comes back.
Section 19: Asbestos, Lead, Silica, and Universal Waste
Section 19 combines four hazardous-material acknowledgments in one declaration:1City of Los Angeles – Department of Building and Safety. LADBS Signature Declaration Form
- Asbestos removal notification either does not apply or has already been filed with the South Coast Air Quality Management District or the EPA under Health and Safety Code Section 19827.5.
- Lead-safe construction practices are required when disturbing paint in buildings built before 1978, per Labor Code Sections 6716 and 6717.
- Silica-safe production practices are required when cutting or fabricating crystalline silica materials, per California Code of Regulations Section 5204.
- Universal waste handling requirements under Title 22, Division 4.5, Chapter 11, Section 66261.9 will be followed.
If your project involves demolition or renovation of materials that may contain asbestos, the AQMD notification has to actually be on file before work begins. Certifying that it “has been submitted” when it has not is a perjury exposure, not just a paperwork delay.
Section 21: Final Declaration
The last section is the blanket certification. Signing 21 confirms that you have read the entire application, that your statements are correct, and that you agree to comply with all city, county, and state laws relating to building construction. You also authorize LADBS representatives to enter the property for inspections.1City of Los Angeles – Department of Building and Safety. LADBS Signature Declaration Form The form states that the permit is an application for inspection; it does not by itself approve the work or permit any violation of law.
Signing Through an Agent or on Behalf of a Business
If someone other than the property owner will sign Section 17a, LADBS requires a separate “Authorization of Agent to Act on Property Owner’s Behalf” form, filled out and signed personally by the owner under penalty of perjury.2California Legislative Information. California Health and Safety Code 19825 When the permit is actually issued, LADBS verifies the owner’s signature — a copy of the owner’s driver’s license, a notarized signature, or another form the agency accepts.3Los Angeles Department of Building and Safety. Owner Builder Permits An agent cannot sign the Notice to Property Owner; that document requires the owner’s own signature unless LADBS gives prior approval otherwise.
When the owner or contractor is a corporation, LADBS requires two officers’ signatures rather than one.4Los Angeles Department of Building and Safety. Covenant and Agreement Regarding Drainage Easement Confirm at the plan check counter which officer combination is acceptable for your entity.
How to Submit the Signed Form
The declaration is not filed on its own. It goes in with the full permit application package. Smaller projects that do not require plan review, such as water heater replacements or basic electrical work, can be applied for through PermitLA at permitla.lacitydbs.org, which uses the City of Los Angeles Angeleno Account for login. Projects that need plan check are submitted through the ePlan electronic review system or in person at an LADBS public counter.
Filing in person has one practical advantage: counter staff can catch a missing checkbox or an unsigned line before your application enters the queue, which is faster than finding out through an email notice days later.
Mistakes That Send the Form Back
- Signing 17a and 17b, or the one that does not match your role.
- Leaving Section 18 blank when working alone. Check the “no employees” box.
- Certifying AQMD asbestos notification when none has been filed.
- Sending an agent to sign 17a without the separate Authorization of Agent form and owner ID verification.
- Leaving the permit application number or job address blank at the top.
How Long the Signed Form Stays Valid
The declaration lives with the permit, so its validity tracks the permit’s. Under Los Angeles Municipal Code Section 98.0602, a building permit expires two years from the date of issuance, and it also expires if work has not started within 12 months or has been suspended, discontinued, or abandoned for any continuous 12-month period.5American Legal Publishing. Los Angeles Municipal Code 98.0602 – Expiration of Permits Extensions may be granted if you can show unusual construction difficulties to the department or the Board. If the permit expires, you file a new application and a new Signature Declaration Form to restart.1City of Los Angeles – Department of Building and Safety. LADBS Signature Declaration Form