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CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newoortbeachca.gov ] (949) 644-3200
IIIs] zI
NOTICE TO PROPERTY OWNER
X�2uaa�- �w4
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified at 5306 Neptune Ave., Newoprt Beach, CA 92663
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to
make you aware of your responsibilities and possible risk you may incur by having this permit issued in
your name as the Owner -Builder.
We will not issue a building permit until you have read, initialed your understanding of each
provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the
permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
\[_1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an
"Owner -Builder" building permit that erroneously implies that the property owner is providing his or her
own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious
financial risk for any injuries sustained by an unlicensed person and his or her employees while working
on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully
acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on my property.
✓ 2. 1 understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
s,/ 3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I
understand that I may protect myself from potential financial risk by hiring a licensed Contractor and
having the permit filed in his or her name instead of my own.
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list
their license numbers on permits and contracts.
_,_/_5. 1 understand if I employ or otherwise engage any persons, other than California licensed
Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor
and materials, I may be considered an "employer" understate and federal law.
6. 1 understand if I am considered an "employer' under state and federal law, I must register with the
state and federal government, withhold payroll taxes, provide workers' compensation disability insurance,
and contribute to unemployment compensation for each "employee." I also understand my failure to abide
by these jaws may subject me to serious financial risk.
V 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds
single-family residential structures cannot legally build them with the intent to offer them for sale, unless
all work is performed by licensed subcontractors and the number of structures does not exceed four
within any calendar year, or all of the work is performed under contract with a licensed general building
Contractor.
V 8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be
held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any
latent construction defects in the workmanship or materials.
Forms\oe er builder verifdoc 08/12/16 1 of
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CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200
SMOKE DETECTOR AND CARBON MONOXIDE
SELF -CERTIFICATION
(this certification is to be filled out by the permittee or homeowner)
Project Address: k-c o4LA. _ _ zLb&
Permit Number: C -
Property Owner -
Licensed Contractor: Lic #:
The State of California now requires that smoke and carbon monoxide detectors must be
installed in all residential buildings
California Residential Code (CRC) Section R314.1, CRC R315.2 states in part that
existing dwellings be "retrofitted with smoke detectors and carbon monoxide detectors.
CRC Section R314.3, CRC R315.3 defines required locations.
Both boxes below must be checked.
Carbon Monoxide Alarm: On the ceiling or wall outside of each separate
/ sleeping area in the immediate vicinity of bedrooms or in each hallway outside of
the rooms, and each level of the dwelling. Detectors are also required in
bed s with gas fired appliances
❑ Smoke Alarms: Installed in each room used for sleeping purpose15, outside
each sleeping area, and on each level of the dwelling unit.
Retrofitted detectors may be battery operated for buildings where no alterations are
performed on the interior. Multiple -purpose alarms (carbon monoxide and smoke alarms)
shall comply with all applicable standards and must be approved by the State Fire
Marshall. The devices must be installed per manufacturer's specifications.
I, the undersigned, hereby certify that I am the permittee or homeowner of the
project. I .tber—ce i moke alarms and carbon monoxide alarms are
prese nd to o be in tional in II the following locations:
Signat I Date: t 30 !1623
NOTE: This se -certification s-o or projects to the exterior of the structure where access to the
interior of the dwelling by the City of Newport Beach Building Inspector is not achieved during the course of
construction.
Forms\SmokeDetectorandCarbonMonoxideSelfCert 08/12/16