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Home My WebLink AboutBLG_Project_Declaration-4.17.2026 Project Declaration Last Updated: 4-17-2026 TMK Property Owner Name Permit Number Project Includes: ☐Building Work ☐Plumbing Work ☐4 bathrooms or more ☐Electrical Work ☐over 200 Amp service STATEMENT ACCOMPANYING PERMIT APPLICATION PURSUANT TO CHAPTER 444, H.R.S. (RELATING TO CONTRACTORS) SELECT BUILDING/GENERAL CONTRACTOR OR OWNER-BUILDER ☐BUILDING/GENERAL CONTRACTOR I declare that I am licensed under the provisions of Chapter 444, HRS, of the Department of Commerce & Consumer Affairs, State of Hawaii. My license# is in full force and in effect. Signature of RME or Sole Proprietor Date NOTE: RME (Responsible Managing Employee) or Sole Proprietor, is required to sign. Building/General Contractor License Name License # Lic. Expiration Date Phone# Business Address RME Full Name RME Work Phone RME Email Address RME Cell Phone ☐OWNER-BUILDER Section 5-1-5 Definition “Owner-builder” means owners or lessees of property who build or improve buildings or structures on their property for their own use, or for use by their immediate family. This definition shall not preempt owner-builder by exemption as defined by section HRS 444-2.5, Hawai`i Revised Statutes I declare an exemption under HRS Sec. 444-2.5 for the following reasons: 1)This exemption allows me, as the owner or lessee of the property, to act as my own general contractor without possessing a license. 2)To supervise the construction myself 3)To hire licensed subcontractors 4)The building is for my personal use and not for the use or occupancy by the general public. 5)Building will not be built for sale or lease within one (1) year after construction is complete. By signing this Project Declaration and declaring exemption under HRS Section 444-2.5, I attest that I have read and understand the “Disclosure Statement” on Page 4. Property Owner Name Property Owner Signature Date Hawaiʻi County is an equal opportunity provider and employer Page 1 of 4 TMK Property Owner Name Permit Number LIST SUBCONTRACTORS When electrical or plumbing work is included, the phases of work and the contractors responsible for each phase must be listed. For a detail ed list of electrical and plumbing w ork phases, refer to page 3 of this form. HCC 5-4-1(a)(9): Provide the name and license number of all specialty c ontractors involved in the project, in compliance with the provisions of chapter 444, Hawai‘i Revised Statutes; Refer to Exhibit A HRS 444-7(d) for the list of specialty contractors. Contractor License Name License # Lic. Expiration Date Work Phone Cell Phone Phase(s) – Must be listed. See lists on page 3 of this form. RME Full Name RME Work Phone RME Email Address RME Cell Phone Signature of RME or Sole Proprietor Date Contractor License Name License # Lic. Expiration Date Work Phone Cell Phone Phase(s) – Must be listed. See lists on page 3 of this form. RME Full Name RME Work Phone RME Email Address RME Cell Phone Signature of RME or Sole Proprietor Date Contractor License Name License # Lic. Expiration Date Work Phone Cell Phone Phase(s) – Must be listed. See lists on page 3 of this form. RME Full Name RME Work Phone RME Email Address RME Cell Phone Signature of RME or Sole Proprietor Date Contractor License Name License # Lic. Expiration Date Work Phone Cell Phone Phase(s) – Must be listed. See lists on page 3 of this form. RME Full Name RME Work Phone RME Email Address RME Cell Phone Signature of RME or Sole Proprietor Date Hawaiʻi County is an equal opportunity provider and employer Page 2 of 4 ELECTRICAL PHASES WRITE PHASE(S) WITHIN SUBCONTRACTOR’S SECTION ON PAGE 2. E1 Temporary Installations E2 Service Equipment HELCO E3 Feeder Wiring E4 Branch Circuit Wiring E5 Electrical Equipment Installation E6 Device and Fixture Installation E7 Fire Alarm System E8 Swimming Pool Wiring E9 Solar Water Heater Wiring E10 Landscape Lighting and Sprinkler Wiring E11 Sign Installation Connection E12 Alt. Energy Installation (PV/Wind/Generator) E13 Low Voltage Wiring Audio/Visual Wiring Security System Wiring Data Communication/Computer Wiring E14 Air Conditioning/Refrigeration Control Wiring E15 Motor Installation E16 Street Lighting/Traffic Signal Installation E17 Empty Conduit Installation E18 Site Work Utilities Installation E19 As Built/Work Started Without Permits E20 Demolition Work PLUMBING PHASES WRITE PHASE(S) WITHIN SUBCONTRACTOR’S SECTION ON PAGE 2. P1 Temporary Water P2 Plumbing Fixtures, Equipment P3a Sanitary Piping System (Interior) P3b Sanitary Piping System (Exterior) P3c Grey Water Waste System P3d Sewe r Lateral Connection(Including Interceptors, Clarifiers) P3e Private Individual Waste System (Including Interceptors, Clarifiers) P3f Private Wastewater Treatment Plants P3g Abandoned Cesspool P4a Water Distribution System (Interior) P4b Building Supply (Outside Water Piping) P4c Water Distribution Main (Subdivision, piping) Pressure RegulatorP4d Wate r Equipment – Backflow Preventer, P4e Water Tank – (Pump/Filter/Water Treatment) P4f Non Potable Water Distribution P5c Standpipes P6a Fuel Gas Piping System and fittings P6b Gas Appliance Qty P7a Solar Water Heating System (Except Water Supply) P7b Solar Water Heater – Water Supply Sanitary Drainage, BackflowP9 Swimming Pool – Potable W ater Supply, P10 Air Conditioning – Water Supply, Including Backflow Preventer P11 Alt. Energy (Heat Pumps, PV Hot Water) P12 Medical Gas System P13 Water Supply for Sprinkler Cross Contamination/ Irrigation Cross Contamination P14 As Built/Work Started Without Permits Hawaiʻi County is an equal opportunity provider and employer Page 3 of 4 Owner-Builder Exemption Under Hawaii Revised Statute Section 444-2.5 "Disclosure Statement" State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption provided in section 444-2.5, Hawaii Revised Statutes, allows you, as the owner or lessee of your property, to act as your own general contractor even though you do not have a license. You must supervise construction yourself. You must also hire licensed subcontractors. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built it for sale or lease, which is a violation of the exemption, and you may be prosecuted for this. It is your responsibility to make sure that subcontractors hired by you have licenses required by state law and by county licensing and ordinances. Electrical or plumbing work must be performed by contractors licensed under chapters 448E and 444, Hawaii Revised Statutes. Any person working on your building who is not licensed must be your employee which means that you must deduct F.I.C.A. and withholding taxes and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, 9 ordinances, building codes, and zoning regulations. If you violate section 444-2.5 or fail to comply with the requirements set forth in this disclosure statement, you may be fined $5,000 or forty per cent of the appraised value of the building as determined by the county tax appraiser, whichever is greater, for the first offense; and $10,000 or fifty per cent of the appraised value of the building as determined by the county tax appraiser, whichever is greater, for any subsequent offense. HRS Section 444-9.1(c) Related Code References HRS 444-2.5 Owner-builder exemption Link to HRS 444-2.5 Owner-builder exemption page HRS 444-9.1 Issuance of building permits; owner-builder registration Link to HRS 444-9.1 Issuance of building permits; owner-builder registration page Hawaiʻi County is an equal opportunity provider and employer Page 4 of 4