Building Division - Forms

Email your application forms to:  

AGENCY APPROVAL FORM  - Agency Acknowledgement and Verification Signatures (i.e., Fire District, Water Supplier, Environmental Management, Air Quality Management, Police Department, Engineering Department, Planning Division, Building Division) required prior to final and issuance of a Certificate of Occupancy.  

Application: Situs Address Assignment form

CONSTRUCTION PERMIT FORMS LISTED BY PART NUMBER:  The forms listed below allow you to pick the forms that are specific to your construction needs.  

Construction Permit Application: Part 1

Owner Builder Declaration (Part 2) (Read: What is an Owner-Builder?)

Water-Conserving Plumbing Fixtures per SB 407PART 4:  (required if doing a remodel where plumbing is involved).   

Re-roof and cool roof verification form: PART 5A (Residential only, Commercial must have CA State form)   

Re-roof shortened Prescriptive Residential Alteration formPART 5B (cool roof only)   

Application Approval Signature of Other AgenciesPART 6

Asbestos Notification at Demolition of Building: PART 7A

Bond and Insurance Verification for Demolition PermitPART 7B

Lead Paint Notification Renovation Pre-1978PART 8

LPG, HVAC, Setback Supplement form: PART 9 (Provide a site plan drawing locating the item(s) that will be permitted).   

Window Fenestration InformationPART 10A

Window Fenestration Prescriptive Residential Alterations California short formPART 10B

Domestic Water Heater DWH Information: PART 11A

Domestic Water Heater T-24 California VersionPART 11B

PART 12   

    A:  Waste Management for Commercial Projects   

    B:  Waste Management for Residential Projects   

   Section C. Materials Waste Management Plan   

   Section D. Materials Waste Management Company   

   Section E. Waste Stream Reduction Alternative (low rise residential)   

    C:  Waste Management Supplement Anticipated Tables   

    D:  Waste Management Supplement Actual Tables   

Special Inspection and Testing Agreement: PART 13

Grading application and informationPART 14

Encroachment application and informationPART 15

PV Solar Expedited Checklist: PART 16

Water and Sewer application informationPART 17

Single Family Dwelling submittal checklistPART 19

Asbuilt Statement (structures or work done without a permit or completed with an expired permit): PART 20




 Development Services Department,  Building Division 
 City Hall, Second Floor
 3101 Center Street
 Placerville, CA 95667
 For general inquiries or to request an appointment: (530) 642-5240
 To request an inspection 24 hours a day: (530) 642-5241