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D E P A R T M E N T O F B U I L D I N G & S A F E T Y 8353 SIERRA AVE, FONTANA, CA 92335 (909) 350-7640 Page 1 of 2 www.fontana.org REV. 05-05-08 OWNER – BUILDER VERIFICATION Job Site Address: Attention Property Owner: An “owner-builder” permit has been, or will be applied for in your name. Please fully complete, notarize, and return this verification form at your earliest opportunity to avoid unnecessary delay in processing and issuing your permit. No permit will be issued until this verification form is completely filled out, signed, notarized, and provided to the City. AUTHORIZATION TO SIGN PERMITS FOR PROPERTY OWNER-BUILDER I hereby affirm that I am the legal owner of the above-referenced property. As owner of this property, I hereby authorize the following person to act on my behalf in obtaining permits from the City of Fontana and to sign any and all applications for me. PERSON AUTHORIZED TO SIGN PERMIT(S) AND THEIR SIGNATURE: (Print Name of Authorized Person) (Signature of Authorized Person) The permit(s) is/are for the following: I assume full responsibility under the law for permits obtained by persons authorized to act on my behalf: By: (Print Property Owner Name – Notarized Below) (Property Owner Signature – Notarized Below) ACKNOWLEDGMENT State of County of On before me, Date Name and Title of Officer “Jane Doe, Notary Public”) personally appeared Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Place Notary Seal Above Signature of Notary Public ---PAGE BREAK--- Page 2 of 2