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Area Code (925) · City Manager 833-6650 · City Council 833-6650 · Personnel 833-6605 · Economic Development 833-6650 Finance 833-6640 · Public Works/Engineering 833-6630 · Parks & Community Services 833-6645 · Police 833-6670 Planning/Code Enforcement 833-6610 · Building Inspection 833-6620 · Fire Prevention Bureau 833-6606 AUTHORIZATION OF AGENT 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: Name of Authorized Agent: Address of Authorized Agent: Phone Number of Authorized Agent: 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. Property Owner’s Signature: Date: Owner Builder Verified: ⃞ Yes ⃞ No Staff Initials 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. When the Owner-Builder Declaration required under subdivision is executed, a Notice to Property Owner shall be executed by the property owner in substantially the same form set forth under this section. The Notice to Property Owner shall appear on the official letterhead of the issuer and shall be provided to the applicant by one of the following methods chosen by the permitting authority: regular mail, electronic format, or given directly to the applicant at the time the application for the permit is made. Except as otherwise provided, the Notice to Property Owner pursuant to this section shall be completed and signed by the property owner and returned prior to issuance of the permit. An agent of the owner shall not execute this notice unless the property owner obtains the prior approval of the permitting authority. A permit shall not be issued unless the property owner complies with this section. * The above requirements and procedures have been imposed by the California Legislature and are not requirements of the City of Dublin. See Health and Safety Code Section 19825