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Building Permit Application (Form)

  1. Title II Compliance

    In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website.

  2. Enter the name of the PERSON applying for the permit

  3. Enter the cost of construction including the price of labor and materials. If there isn't a cost, please enter $200

  4. Enter the APPLICANT"S email address

  5. Enter the address for the project

  6. Owner's Last Name or the name of the entity owning the property

  7. Enter the owner's address

  8. State

  9. Enter the owner's zip code

  10. Enter the owner's phone number

  11. Enter the owner's email address

  12. Owner lives at project address

    Check this box if the owner lives at the project address

  13. Enter the COMPANY NAME of the contractor

  14. Enter the phone number for the contractor

  15. Enter the contractor's license number

  16. Enter the BUSINESS license number for the contractor

  17. Enter the name of the designer's COMPANY

  18. Enter the designer's email

  19. Enter the phone number for the designer

  20. Enter a brief description of the proposed work

  21. Certification

    I certify that I have read this application and state that the above information is CORRECT. I AGREE TO COMPLY with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes

  22. Enter your name as evidence of making the above certification

  23. LICENSED CONTRACTOR'S DECLARATION

    I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. I have secured permission from the property owner to obtain this permit

  24. OWNER BUILDER DECLARATION

    I hereby affirm under penalty of perjury that I am exempt from the Contractor’s License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor’s License Law (Chapter 9, (commencing with Section 7000), of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom 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).):

  25. WORKER'S COMPENSATION DECLARATION

    I hereby affirm under penalty of perjury one of the following declarations:

  26. Enter Your name as making the above worker's compensation declaration

  27. Leave This Blank:

  28. This field is not part of the form submission.