Orbeon Demo: Building Permit Application

This form is inspired by real-life building permit application forms. It shows:

a sophisticated layout of form controls on wide screens
an automatic vertical layout on narrow screens such as phones
explanatory texts
section templates
nested grids and sections (subsections)
email, date, and phone number fields
the Handwritten Signature form control
conditional validation
about 80 form controls, grids and sections

Type of projectMissing or incorrect value

Job Valuation Missing or incorrect valueCost of labor and materials

Scope of workMissing or incorrect value

Project address

Street address

Street address line 2

CityMissing or incorrect value

State, territory, or military post

Zip codeMissing or incorrect value

Property owner

Property owner nameMissing or incorrect value

Property owner emailMissing or incorrect value

Property owner phone Missing or incorrect value

Property management/tenant name

Property owner mailing address

Street address

Street address line 2

CityMissing or incorrect value

State, territory, or military post

Zip codeMissing or incorrect value

Contractor/owner-builder

Type of contractorMissing or incorrect value

Contractor state license #Missing or incorrect value

License classMissing or incorrect value

Expires Missing or incorrect value

Company/owner-builder's nameMissing or incorrect value

Business license #Missing or incorrect value

Email addressMissing or incorrect value

Phone Missing or incorrect value

Applicant/authorized agent's nameMissing or incorrect value

Email addressMissing or incorrect value

Phone Missing or incorrect value

Mailing address

Street address

Street address line 2

CityMissing or incorrect value

State, territory, or military post

Zip codeMissing or incorrect value

Architect/engineer/designer

TypeMissing or incorrect value

NameMissing or incorrect value

Company nameMissing or incorrect value

License #Missing or incorrect value

Email addressMissing or incorrect value

Phone Missing or incorrect value

Mailing address

Street address

Street address line 2

CityMissing or incorrect value

State, territory, or military post

Zip codeMissing or incorrect value

I certify that I have read this application and state that the above information is correct. I agree to comply with all city 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.

Name (licensed contractor/authorized agent)Missing or incorrect value

Date Missing or incorrect value

Signature

Missing or incorrect value

[Specific terms here.] I have read the above information and understand it. This information will be passed along to the property owner in a timely manner by the contractor if the property owner is not the person signing this form.

Name (licensed contractor/authorized agent)Missing or incorrect value

Date Missing or incorrect value

Signature

Missing or incorrect value

Licensed Contractor Declaration: I hereby affirm under penalty of perjury 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.

Name (licensed contractor/authorized agent)Missing or incorrect value

Date Missing or incorrect value

Signature

Missing or incorrect value

Workers’ Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations:

I have and will maintain a certificate of consent to self-insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My policy number is:

Policy number

I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance is:

Carrier

Policy number

Expires

I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.

Name (licensed contractor/authorized agent)Missing or incorrect value

Date Missing or incorrect value

Signature

Missing or incorrect value

Warning: Failure to secure workers' compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, and damages as provided for in Section 306 of the Labor Code, interest, and attorney's fees.

Notes

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Orbeon Demo: Building Permit Application

Project information

Project address

Project contact

Property owner

Property owner mailing address

Contractor/owner-builder

Mailing address

Architect/engineer/designer

Mailing address

Certification

Agreement

Declarations