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Home My WebLink AboutE2021-0813 - Misc�F '02-1- 6&\,S 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 1 (949) 644-3200 OWNER -BUILDER ACKNOWLEDGEMENT AND INFORMATION VERIFICATION (HSC 19825) NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted_jn your name listing yourself as the builder of the property improvements specified at (I 3 2—tTi+ S i 67 ra(a`J 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 provision, signed, and returned this form to us owner cannot execute this notice unless you, th permitting authority. have read, initialed your understanding of each at our official address indicated. An agent of the property owner, obtain the prior approval of the OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION . . DIRECTIONS: Read and initial each statement below to signify you understand or verify this inforjrfdtfdrf. M1. I understand a frequent practice of unlicensed persons is to have the property owner (Viair�an "Owner -Builder" building permit that erroneously implies that the property owner is providing his of'her own labor and material personally. 1, 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.wor`king 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+Norkees on my property. ° ` _ff 2. 1 understand building permits are not required to be signed by property owners unless "y are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. _L3. I understand as an "Owner -Builder" I am the responsible party of record on the pm rrnit°ol 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. �C4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. -U-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" under state and federal law. W6. 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 laws may subject me to serious financial risk. 0 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. 0 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. FoanAovmer builder verifdoe 08/12/16 1 of2 �_fb I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. K 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the partyy legally and financially responsible for proposed construction activity at the following address: (ll y 1.� St/ �F IT 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and-returnedtothe-Ci"f-NewpodBeach,_Buitd ing Division,_forissuing thie_permit.—__ _ -- A4*v;A copy of the property owner's driver's license or form notarization is required to be presented when the permit is issued to verify the property owner's signature. • Pril name of property owner: Date: sC { Date:Prp.p.p.y.Owner's Signature: jkt lA �01 c7 d •' •.' • Note: The following Authorization Form is required to be completed by the property owner only when.. signating an agent of the property owner to apply for a construction permit for the •,,,,, 6wnewB er. AUT RIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice o Property Owner, the execution of which I understan s my personal responsibility, I hereby au prize the following person(s) to act as my agent(s) to y for, sign, and file the documents necessary to tain an Owner -Builder Permit for my project. Scope of Construction Project ( Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of per' that I am the pXle-Is the address listed above and I personally filled out the abo information and certife: A copy of the owners drivers license, form notarizatio r other verification acceptrequired to be presented when thepermit isissuedt erify the property owner's sign Property Ow s Signature: Date: Note: opy of the owner's driver's license or form notarization is required t e presented when the permit is issued to verify the property owner's signature. Forms\owner builder verifdoc 08/12/16 2 of 2