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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.00v 1 (949) 644-3200
NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application fora building permit has been su,bJ�fitted ipp�r� our narnelistigg yoWrself as the buil er f
the property improvements specified at �% V PKIM cddoo /l`�lfi ko alp
We are providing you with an Owner -Builder Acknowledgment and Information VerificatioA 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.
19� - 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.
1spo2 1 understand building permits are not required to be signed by property owners unless they are
nsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I
derstand that I may protect myself from potential financial risk by hiring a licensed Contractor and
a : g 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
ontractors, and the total value of my construction is at least five hundred dollars ($500), including labor
6 kndmaterials, I may be considered an "employee' under state and federal law.
6. 1 understand if I am considered an "employer' under state and federal law, I must register with the
and federal government, withhold payroll taxes, provide workers' compensation disability insurance,
d contribute to unemployment compensation for each "employee:' I also understand my failure to abide Zth se laws may subject me to serious financial risk.
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
ethin any calendar year, or all of the work is performed under contract with a licensed general building
o tractor.
_8. 1 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\ow er_builder_verifdoc 08/12/16 1 of